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Tissue Expansion for Single Stage Ear Reconstruction using Hyaluronic Acid Filler: A Novel Concept for Difficult Areas
Amir Inbal, MD1, Benjamin T. Lemelman, MD1, Eran Millet, MD2, Andrew Greensmith, MD2.
1University of Chicago Section of Plastic and Reconstructive Surgery, Chicago, IL, USA, 2Melbourne Institute of Plastic Surgery, Malvern, Australia.

PURPOSE
Auricular reconstruction is one of the most challenging procedures in plastic surgery. An adequate skin envelope is essential for cartilage framework coverage, yet few good options exist without additional surgery. We propose a novel method for minimally invasive tissue expansion using hyaluronic acid (HA) filler to allow for single stage ear reconstruction.
METHODS
Macrolane is a large particle biphasic HA gel, composed of stabilized HA of non-animal origin developed for volume restoration and soft tissue contouring. Off-label expansion of the non-hair-bearing mastoid skin is performed in clinic weekly or every other week. Average expansion is 2 ml per session. Patients undergo assessments of skin color, thickness, pliability, capillary refill, tightness, and tenderness before, during and after each session. Final expansion is performed one week prior to surgery.
Additionally, tissue from one patient’s expanded pocket was sent for histological analysis using Hematoxylin and eosin stain (H&E stain).
RESULTS
Ten patients underwent single stage auricular reconstruction with pre-operative expansion. Mean total number of sessions was 9.70. Mean injected volume per session was 2.03 ml per patient, for an average total of 19.8 ml. No complications related to Macrolane occurred. One minor complication was seen 1 year post-op related to exposed wire. H&E stain revealed similar histology to that seen with traditional expanders.
CONCLUSIONS -
This novel expansion technique using serial Macrolane injections allowed for optimized skin coverage of the costal cartilage framework in single stage ear reconstruction. Future studies should explore tissue expansion of other difficult areas using this technique.


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