Revision Meatoplasty: Management Emphasizing De-Epithelialized Postauricular Flaps

Abstract

Revision meatoplasty represents a unique reconstructive dilemma to the otolaryngologist. Often, the external canal and conchal skin are or have been involved in an inflammatory process and subsequent scarring that compromises or precludes its use in a reconstructive procedure. Our technique recommends one or more tongues of postauricular normal vascularized skin flaps be developed and rotated into the ear canal. The portion lying beneath the auricle is de-epithellalized as it is tunnelled under the conchal bowl. This random postauricular flap permits the introduction of healthy skin at the flap's tip for resurfacing the canal and meatus. Because the flap is introduced from a posterior direction, the inevitable scarring and forces of contraction serve to keep the meatus patent. This is in marked contrast to usual repair attempts that introduce coverage at the meatus with a skin graft, which subsequently heals, with a circumferential scar compounding the stenosis. The exact design of the flap is generally determined by the presence or absence of previous postauricular healed scar. There is most often a previous postauricular incision from ear surgery that dictates the exact design of the flap or flaps. Superiorly and/or inferiorly based flaps have been used successfully. The segment that lies beneath the auricle is de-epitheliallzed using the CO2 laser. This greatly facilitates the speed and precision of the de-epithelializing maneuver. To date, 32 cases of conchal and external canal stenosis have been successfully managed using this technique. The indications, technical description, and representative examples are the basis of this manuscript, which offers the otolaryngologist a viable option in revision meatoplasty.