Auricular reconstruction with a postauricular myocutaneous island flap: Flip-flop flap

The revolving door flap could be the reconstructive procedure of choice for the auricular concha following skin cancer excision, based on low risk of necrosis, infection, and postoperative hemorrhage and excellent aesthetic outcomes.

“Qualitative synthesis of the results concluded that the revolving door flap could be the reconstructive procedure of choice for the auricular concha, following skin cancer excision.”

The main disadvantage of the revolving door flap is its tendency to produce pinning of the auricle to the scalp.

“its main disadvantage is its tendency to produce pinning of the auricle to the scalp [3,4,5,6,7,8,9].”

STSG may be used as an alternative to the revolving door flap for conchal bowl reconstruction.

“STSG may be used as an alternative.”

Among studies reporting complications of the revolving door flap, only Talmi et al. reported one case of infection after 11 flaps (9.1%), while other more recent studies found no cases of infection.

“Talmi et al. reported only one case of infection after performing 11 revolving door flaps (9.1%), whereas other more recent studies (Zhu (2016), Iljin (2018), Iljin (2016), Dyson (2019)) documenting this complication did not find any cases of infection [4,6,7,8,9].”

The revolving door flap has excellent survival rates.

“Furthermore, this flap has excellent survival rates, as all six studies recording flap necrosis incidence found no cases of this complication [3,4,5,6,8,9].”

Secondary intention healing poses a greater risk of infection compared to the revolving door flap.

“Secondary intention healing poses a greater risk of infection, as compared to the revolving door flap [2,3,4,5,6,7,8,9,12,18].”

No cases of necrosis or failure of the flap or graft occurred in any of the six papers that examined this complication for the revolving door flap.

“Likewise, necrosis or failure of the flap or graft did not occur in any of the six papers that contemplated this complication [3,4,5,6,8,9].”

The revolving door flap has little tendency to develop infections.

“It may be concluded that the revolving door flap has little tendency to develop infections.”

Overall, the risk of bias for the enrolled case series was low following assessment with the JBI Critical Appraisal Checklist for Case Series.

“Overall, the risk of bias for the enrolled case series was low following assessment with the JBI Critical Appraisal Checklist for Case Series [1,4,5,6,7,8,9,10,12,16].”

Talmi (1996) scored 6/10 on the JBI checklist, rendering its risk of bias concerning, mainly due to lack of clear inclusion criteria and failure to have consecutive and complete inclusion.

“However, Talmi (1996) [8] scored 6/10, rendering its risk of bias concerning [8,16]. Its main issue was a lack of clear inclusion criteria for the study’s participants, as well as its failure to have consecutive and complete inclusion [8,16].”

Aesthetic results were reported in a heterogeneous manner across included studies.

“while complications were presented in the form of incidences in all included studies, aesthetic results were reported in a heterogeneous manner [1,2,3,4,5,6,7,8,9,10,12,18].”

Talmi (1996) reported an 18.2% incidence of surgical wound dehiscence after revolving door flap reconstruction, but these patients were well above the mean age.

“Dehiscence was only considered as a potential complication in Talmi (1996), where 18.2% of cases resulted in this outcome; however, it must be noted that these patients were well above the mean age [8].”

Not all included studies presented data on the two outcomes considered in this review.

“Not all included studies presented data on the two outcomes considered in this review [1,2,3,4,5,6,7,8,9,10,12,18].”

Most included studies had a long follow-up period, ensuring that even long-term complications and aesthetic defects were detected.

“For instance, most included studies had a long follow-up period, ensuring that even long-term complications and aesthetic defects were detected [1,2,3,4,5,6,7,8,9,10,12,18].”

All existing reconstructive procedures applicable to the auricular concha were explored in this review.

“More importantly, all existing reconstructive procedures applicable to the auricular concha were explored [1,2,3,4,5,6,7,8,9,10,12,18].”

This review can provide a global perspective because it comprises studies from several countries conducted by different specialists.

“Moreover, this review can provide a global perspective as it comprises studies from several countries conducted by different specialists (dermatologists, otorhinolaryngologists, or plastic surgeons) [1,2,3,4,5,6,7,8,9,10,12,18].”