April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Plastic and Reconstructive Surgery • November 2018

Fig. 7. Case 1. The patient is shown at age 4, after bilateral otoplasty.

and subtle contour defects. All patients were fol- lowed at 3-month intervals postoperatively up to 1 year and yearly thereafter, with a minimum follow-up of 1 year, and all patients had sustained facial contour and symmetry up to over 20 years postoperatively. The incidence of hematoma was relatively high at 7 percent (12 of 177); four of these hematomas were drained at the bedside and eight required reoperation. Fortunately, these hematomas were

quickly recognized and did not compromise the ultimate reconstructive result. Hemostasis can be a challenge because of the limited preauricular incision and the robust blood supply of the cen- tral face; thus, extra care must be taken when pre- paring the recipient site before flap inset. Beyond the area where direct visualization can be per- formed through the limited preauricular incision, we prefer to pack the dissected facial site before the revascularization of the flap tissues, and then exchange the facial packing for the transferred

Fig. 8. Case 1. The patient is shown at age 8, with stable results, 5 years after initial correction.

Fig. 9. Case 1. The right parascapular donor site is demonstrated.

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