VIDEOS OF SURGICAL PROCEDURES IN DERMATOLOGY
Cartilage Graft in the Reconstruction of the Pinna of the Ear
Injerto de cartílago en la reconstrucción del pabellón auricular
B. González-Sixto
, A. Pérez-Bustillo, E. Samaniego, M.A. Rodríguez-Prieto
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Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain
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González-Sixto, A. Pérez-Bustillo, E. Samaniego, M.A. Rodríguez-Prieto" "autores" => array:4 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "González-Sixto" "email" => array:1 [ 0 => "bgonsix@aedv.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Pérez-Bustillo" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Samaniego" ] 3 => array:2 [ "nombre" => "M.A." "apellidos" => "Rodríguez-Prieto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding Author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Injerto de cartílago en la reconstrucción del pabellón auricular" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1667 "Ancho" => 1240 "Tamanyo" => 344340 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Surgical defect affecting the cartilage of the antitragus.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Description</span><p id="par0005" class="elsevierStylePara elsevierViewall">Complete excision of a neoplastic lesion on the pinna of the ear may affect the cartilaginous skeleton of this structure (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In contrast to the situation with other facial structures, surgery to the ear has few functional repercussions. However, cosmetic changes due to scar retraction during the healing process are common.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Substitution of the cartilage is possible using alloplastic materials or autologous cartilage grafts.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Cartilage grafts can be of elastic cartilage (the concha or antihelix of the ear) or of hyaline cartilage (from the nasal septum or costal cartilage). Elastic cartilage is ideal for reconstruction of the pinna as it retains its original shape after the healing process.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Hyaline cartilage is harder and more resistant but less malleable, and therefore less suitable for this site.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A cartilage graft must be of a similar shape to the defect and of a slightly larger size. If possible, the graft should be fixed to the perichondrium; otherwise the cartilage is introduced into dermal “pockets” and fixed with resorbable suture (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Cartilage grafts are used in combination with local flaps for skin cover.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The survival of cartilage grafts is excellent, with reported rates of around 95% at 20 years. Survival depends on several factors: blood supply to the recipient site, size of the graft, manipulation of the cartilage, postoperative trauma, and the presence or absence of overlying and underlying perichondrium.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Technique</span><p id="par0030" class="elsevierStylePara elsevierViewall">The surgical technique can be seen in the video of the procedure.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0035" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Cartilage grafts are indicated for the repair of cartilaginous defects of the pinna of the ear—particularly defects of the helix—that cause asymmetry or functional alterations,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> such as a lack of support for glasses. These grafts can also occasionally be used to provide greater firmness to specific anatomical subunits, such as in reconstruction of the earlobe.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">The technique is also indicated at other sites, such as the lower eyelid or the ala nasi, where it is used after excision of the supportive tissues (tarsus, cartilage) to prevent the risk of ectropion or collapse of the nares during inspiration.</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0050" class="elsevierStylePara elsevierViewall">Cartilage grafts should not be used at sites with a poor blood supply, such as over scar tissue, as this will deprive the cartilage of oxygen and nutrients.</p><p id="par0055" class="elsevierStylePara elsevierViewall">These grafts are not suitable for defects larger than 1.5<span class="elsevierStyleHsp" style=""></span>cm as their viability is limited and the excision from the donor site may leave a deformity.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Complications</span><p id="par0060" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Short-term and long-term results are usually good, with very few complications.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Chondritis or perichondritis may develop at the donor site; these may be sterile, induced by manipulation of the cartilage, or secondary to infection, often due to <span class="elsevierStyleItalic">Pseudomonas</span> species.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">Graft extrusion, deformation, or displacement is usually due to inadequate fixation.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="par0080" class="elsevierStylePara elsevierViewall">The surgical technique for cartilage grafts is simple and the results are very good. These grafts are indicated for small and medium-sized defects that cause functional and/or cosmetic impairment due to the absence of the cartilaginous support. The technique is usually performed in a single operation and carries no additional costs as no alloplastic materials are used.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Description" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "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" => "xack57455" "titulo" => "Acknowledgments" ] 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: González-Sixto B, et al. Injerto de cartílago en la reconstrucción del pabellón auricular. Actas Dermosifiliogr. 2013;104:633–4.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0095" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0040" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1667 "Ancho" => 1240 "Tamanyo" => 344340 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Surgical defect affecting the cartilage of the antitragus.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1667 "Ancho" => 1242 "Tamanyo" => 211850 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cartilage graft to the antitragus fixed with resorbable suture.</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 78003779 "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:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spectrum of cartilage grafting in cutaneous reconstructive surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.C. Otley" 1 => "D.A. Sherris" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1998" "volumen" => "39" "paginaInicial" => "982" "paginaFinal" => "992" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9843013" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Composite and cartilage grafting" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Adams" 1 => "D. Ratner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.det.2004.08.005" "Revista" => array:6 [ "tituloSerie" => "Dermatol Clin" "fecha" => "2005" "volumen" => "23" "paginaInicial" => "129" "paginaFinal" => "140" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15620624" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The incidences of chondritis and perichondritis associated with the surgical manipulation of auricular cartilage" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.L. Kaplan" 1 => "J.L. Cook" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2004" "volumen" => "30" "paginaInicial" => "58" "paginaFinal" => "62" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14692929" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack57455" "titulo" => "Acknowledgments" "texto" => "<p id="par0085" class="elsevierStylePara elsevierViewall">We would like to thank José Lavigne Pérez for his invaluable help in the production of this video.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000007/v1_201308270818/S1578219013001510/v1_201308270818/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/15782190/0000010400000007/v1_201308270818/S1578219013001510/v1_201308270818/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013001510?idApp=UINPBA000044" ]
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| 2024 Septiembre | 207 | 53 | 260 |
| 2024 Agosto | 265 | 107 | 372 |
| 2024 Julio | 289 | 68 | 357 |
| 2024 Junio | 166 | 42 | 208 |
| 2024 Mayo | 167 | 43 | 210 |
| 2024 Abril | 160 | 35 | 195 |
| 2024 Marzo | 163 | 51 | 214 |
| 2024 Febrero | 175 | 49 | 224 |
| 2024 Enero | 155 | 45 | 200 |
| 2023 Diciembre | 189 | 35 | 224 |
| 2023 Noviembre | 196 | 50 | 246 |
| 2023 Octubre | 164 | 65 | 229 |
| 2023 Septiembre | 149 | 56 | 205 |
| 2023 Agosto | 125 | 42 | 167 |
| 2023 Julio | 125 | 61 | 186 |
| 2023 Junio | 110 | 52 | 162 |
| 2023 Mayo | 129 | 45 | 174 |
| 2023 Abril | 82 | 42 | 124 |
| 2023 Marzo | 93 | 45 | 138 |
| 2023 Febrero | 86 | 33 | 119 |
| 2023 Enero | 39 | 49 | 88 |
| 2022 Diciembre | 66 | 69 | 135 |
| 2022 Noviembre | 41 | 38 | 79 |
| 2022 Octubre | 29 | 40 | 69 |
| 2022 Septiembre | 45 | 48 | 93 |
| 2022 Agosto | 26 | 34 | 60 |
| 2022 Julio | 25 | 39 | 64 |
| 2022 Junio | 36 | 38 | 74 |
| 2022 Mayo | 113 | 50 | 163 |
| 2022 Abril | 93 | 40 | 133 |
| 2022 Marzo | 94 | 67 | 161 |
| 2022 Febrero | 71 | 26 | 97 |
| 2022 Enero | 104 | 45 | 149 |
| 2021 Diciembre | 74 | 48 | 122 |
| 2021 Noviembre | 102 | 45 | 147 |
| 2021 Octubre | 100 | 56 | 156 |
| 2021 Septiembre | 102 | 56 | 158 |
| 2021 Agosto | 79 | 40 | 119 |
| 2021 Julio | 73 | 27 | 100 |
| 2021 Junio | 55 | 17 | 72 |
| 2021 Mayo | 61 | 46 | 107 |
| 2021 Abril | 79 | 61 | 140 |
| 2021 Marzo | 94 | 28 | 122 |
| 2021 Febrero | 84 | 30 | 114 |
| 2021 Enero | 66 | 31 | 97 |
| 2020 Diciembre | 47 | 38 | 85 |
| 2020 Noviembre | 33 | 28 | 61 |
| 2020 Octubre | 49 | 12 | 61 |
| 2020 Septiembre | 30 | 15 | 45 |
| 2020 Agosto | 21 | 23 | 44 |
| 2020 Julio | 31 | 16 | 47 |
| 2020 Junio | 38 | 30 | 68 |
| 2020 Mayo | 37 | 12 | 49 |
| 2020 Abril | 34 | 24 | 58 |
| 2020 Marzo | 40 | 18 | 58 |
| 2020 Febrero | 6 | 1 | 7 |
| 2020 Enero | 1 | 1 | 2 |
| 2019 Diciembre | 8 | 16 | 24 |
| 2019 Noviembre | 4 | 5 | 9 |
| 2019 Octubre | 1 | 7 | 8 |
| 2019 Septiembre | 11 | 9 | 20 |
| 2019 Agosto | 7 | 9 | 16 |
| 2019 Julio | 4 | 11 | 15 |
| 2019 Junio | 4 | 9 | 13 |
| 2019 Mayo | 8 | 48 | 56 |
| 2019 Abril | 2 | 27 | 29 |
| 2019 Marzo | 0 | 9 | 9 |
| 2019 Febrero | 4 | 3 | 7 |
| 2019 Enero | 0 | 11 | 11 |
| 2018 Diciembre | 3 | 6 | 9 |
| 2018 Noviembre | 3 | 3 | 6 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 5 | 0 | 5 |
| 2018 Mayo | 0 | 4 | 4 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 67 | 8 | 75 |
| 2018 Enero | 51 | 7 | 58 |
| 2017 Diciembre | 87 | 6 | 93 |
| 2017 Noviembre | 47 | 6 | 53 |
| 2017 Octubre | 56 | 2 | 58 |
| 2017 Septiembre | 56 | 5 | 61 |
| 2017 Agosto | 57 | 7 | 64 |
| 2017 Julio | 42 | 6 | 48 |
| 2017 Junio | 78 | 11 | 89 |
| 2017 Mayo | 56 | 9 | 65 |
| 2017 Abril | 62 | 9 | 71 |
| 2017 Marzo | 43 | 30 | 73 |
| 2017 Febrero | 110 | 7 | 117 |
| 2017 Enero | 60 | 13 | 73 |
| 2016 Diciembre | 61 | 20 | 81 |
| 2016 Noviembre | 81 | 13 | 94 |
| 2016 Octubre | 154 | 16 | 170 |
| 2016 Septiembre | 176 | 9 | 185 |
| 2016 Agosto | 123 | 5 | 128 |
| 2016 Julio | 49 | 3 | 52 |
| 2016 Junio | 10 | 0 | 10 |
| 2016 Mayo | 15 | 9 | 24 |
| 2016 Abril | 4 | 4 | 8 |
| 2016 Marzo | 3 | 1 | 4 |
| 2016 Febrero | 5 | 9 | 14 |
| 2016 Enero | 4 | 7 | 11 |
| 2015 Diciembre | 8 | 12 | 20 |
| 2015 Noviembre | 22 | 1 | 23 |
| 2015 Octubre | 8 | 14 | 22 |
| 2015 Septiembre | 7 | 4 | 11 |
| 2015 Agosto | 7 | 5 | 12 |
| 2015 Julio | 111 | 4 | 115 |
| 2015 Junio | 57 | 1 | 58 |
| 2015 Mayo | 48 | 7 | 55 |
| 2015 Abril | 46 | 10 | 56 |
| 2015 Marzo | 73 | 12 | 85 |
| 2015 Febrero | 83 | 1 | 84 |
| 2015 Enero | 29 | 5 | 34 |
| 2014 Diciembre | 39 | 3 | 42 |
| 2014 Noviembre | 27 | 2 | 29 |
| 2014 Octubre | 50 | 5 | 55 |
| 2014 Septiembre | 36 | 1 | 37 |
| 2014 Agosto | 38 | 9 | 47 |
| 2014 Julio | 35 | 5 | 40 |
| 2014 Junio | 40 | 8 | 48 |
| 2014 Mayo | 45 | 9 | 54 |
| 2014 Abril | 39 | 0 | 39 |
| 2014 Marzo | 53 | 12 | 65 |
| 2014 Febrero | 39 | 6 | 45 |
| 2014 Enero | 28 | 2 | 30 |
| 2013 Diciembre | 31 | 6 | 37 |
| 2013 Noviembre | 28 | 8 | 36 |
| 2013 Octubre | 14 | 3 | 17 |
| 2013 Septiembre | 15 | 6 | 21 |
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