Videos of Surgical Procedures in Dermatology
Incomplete Cleft Earlobe Reconstruction Using a Z-plasty or Hammock Flap
Reconstrucción de lóbulo rasgado incompleto mediante media z plastia o colgajo en hamaca
E. Vargas-Laguna
, A. Imbernón-Moya, A. Lobato Berezo
Corresponding author
Servicio de Dermatología, Hospital Universitario Severo Ochoa, Madrid, Spain
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Vargas-Laguna, A. Imbernón-Moya, A. Lobato Berezo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Vargas-Laguna" "email" => array:1 [ 0 => "evargaslaguna@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Imbernón-Moya" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Lobato Berezo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Severo Ochoa, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reconstrucción de lóbulo rasgado incompleto mediante media z plastia o colgajo en hamaca" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In cleft earlobes, the split can be complete or incomplete, depending on whether or not the defect reaches the free border of the lobe. There are many reconstruction techniques, from direct closure to classic Z-plasties.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Choice of the appropriate surgical procedure is based on an evaluation of the site of the cleft orifice, symmetry with the contralateral lobe, and possible lengthening of the lobe. It should also be planned whether to maintain the initial orifice or, in contrast, to create a new perforation after the intervention.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In 1996, Abenavoli<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> first described the use of a half Z-plasty to reconstruct complete and incomplete cleft earlobes. The advantage of this technique over the traditional Z-plasty is maintenance of the original orifice and the fact that it is a simple and quick procedure.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In 1998, Gayiwala<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> described the use of a similar technique for reconstruction of the cleft lobes. This method, which he called the hammock flap, avoided producing a pointed lobe, as can occur after reconstruction with the classic Z-plasty, and left an oblique scar. In complete defects, he added a small L-flap at the free border of the lobe to prevent notches.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The advantages of this technique compared with direct closure were that it has a lower recurrence rate and that the reconstructed lobe has a natural, round silhouette; it was also preferable to the punch technique for lobes with a limited volume of tissue.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We present the case of an incomplete cleft lobe in a 34-year-old patient. The defect occupied the lower two thirds of the left earlobe and was not associated with lengthening of the lobe. We decided to perform reconstruction using a half Z-plasty or hammock technique, maintaining the original orifice.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of the Technique</span><p id="par0030" class="elsevierStylePara elsevierViewall">After designing the flap, local anesthesia is administered with 1% mepivacaine plus 1:200<span class="elsevierStyleHsp" style=""></span>000 epinephrine. A hook is used to hold the lobe in a fixed position. An elliptical incision is made to refresh the borders of the central part of the cleft, where the orifice had split, maintaining the upper part intact. An incision is then made at the extremes of the Z, penetrating through to the posterior surface of the lobe. This creates 2 triangular flaps that are transposed across the central area, embracing the original orifice that is left at the superior end of the incision.</p><p id="par0035" class="elsevierStylePara elsevierViewall">After placing subcutaneous sutures with a 5/0 absorbable material such as polyglactin, suturing of the skin is started on the anterior surface of the lobe, with interrupted sutures with 5/0 monofilament polypropylene. A 3/0 braided silk thread is left in the remaining orifice and the patient is advised to move this thread several times a day for the next 3 weeks, when a small earring can be inserted. Sutures are removed 10 days after the operation.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The procedure is similar in lobes with a complete cleft, performing the Z-plasty at the midpoint of the defect.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0045" class="elsevierStylePara elsevierViewall">Reconstruction of complete and incomplete earlobe clefts when it is desired to preserve the original orifice.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0050" class="elsevierStylePara elsevierViewall">Very long earlobes with a (relative) excess of tissue.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Complications</span><p id="par0055" class="elsevierStylePara elsevierViewall">An unsightly scar may remain in some patients and, as with any Z-plasty, necrosis of the tips of the flaps can occur. As there is no tension, subcutaneous suture, which could compromise the tips of the flaps, is not necessary.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Another possible complication is recurrence of the cleft lobe, although this complication is more likely when the original orifice is maintained during the reconstruction. This stepped closure provides considerable support to the orifice.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="par0065" class="elsevierStylePara elsevierViewall">The modified Z-plasty technique or hammock flap is a simple and rapid reconstruction technique for cleft earlobes and has a good cosmetic result. According to some studies, maintenance of the original orifice leads to greater patient satisfaction.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> The procedure is useful for both complete and incomplete earlobe clefts; preservation of the original orifice will maintain symmetry with the orifice in the other lobe. Additionally, when there is a complete cleft, this technique prevents the appearance of notches, as can occur with any Z-plasty.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Description of the Technique" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Contraindications" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Complications" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vargas-Laguna E, Imbernón-Moya A, Lobato Berezo A. 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Actas Dermosifiliogr. 2016;107:775–776.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0080" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0045" ] ] ] ] "multimedia" => array:1 [ 0 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 37638097 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Split earlobe: Repair using a half Z-plasty technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.M. Abenavoli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "1996" "volumen" => "98" "paginaInicial" => "372" "paginaFinal" => "373" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8764733" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Repair of cleft earlobe using double opposing Z-plasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. 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Greenbaum" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2000.105562" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2000" "volumen" => "43" "paginaInicial" => "99" "paginaFinal" => "101" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10863232" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eleven pearls for cosmetic earlobe repair" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Niamtu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2002" "volumen" => "28" "paginaInicial" => "180" "paginaFinal" => "185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11860433" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000009/v1_201611010039/S1578219016302153/v1_201611010039/en/main.assets" "Apartado" => array:4 [ "identificador" => "6209" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Videos of Surgical Procedures in Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010700000009/v1_201611010039/S1578219016302153/v1_201611010039/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016302153?idApp=UINPBA000044" ]
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| 2021 January | 32 | 15 | 47 |
| 2020 December | 16 | 18 | 34 |
| 2020 November | 30 | 18 | 48 |
| 2020 October | 16 | 14 | 30 |
| 2020 September | 22 | 17 | 39 |
| 2020 August | 23 | 22 | 45 |
| 2020 July | 30 | 17 | 47 |
| 2020 June | 34 | 32 | 66 |
| 2020 May | 39 | 19 | 58 |
| 2020 April | 38 | 22 | 60 |
| 2020 March | 36 | 8 | 44 |
| 2020 February | 3 | 0 | 3 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 2 | 0 | 2 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 3 | 0 | 3 |
| 2019 May | 4 | 0 | 4 |
| 2019 April | 2 | 5 | 7 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 3 | 0 | 3 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 4 | 0 | 4 |
| 2018 February | 27 | 4 | 31 |
| 2018 January | 41 | 16 | 57 |
| 2017 December | 49 | 15 | 64 |
| 2017 November | 26 | 7 | 33 |
| 2017 October | 30 | 13 | 43 |
| 2017 September | 23 | 10 | 33 |
| 2017 August | 28 | 12 | 40 |
| 2017 July | 45 | 15 | 60 |
| 2017 June | 33 | 18 | 51 |
| 2017 May | 26 | 15 | 41 |
| 2017 April | 33 | 8 | 41 |
| 2017 March | 21 | 22 | 43 |
| 2017 February | 21 | 14 | 35 |
| 2017 January | 16 | 12 | 28 |
| 2016 December | 24 | 39 | 63 |
| 2016 November | 42 | 33 | 75 |
| 2016 October | 4 | 13 | 17 |
Show all
