The DOI matches its Crossref record; 14 of the 14 references it cites were found in a registry or an index.
The postauricular fascial flap as an adjunct to Mustardé and Furnas type otoplasty.
Abstract
Anterior riberation methods of otoplasty have been criticized because of the risk of anterior hematoma that can cause anterior skin necrosis, scarring, and even cartilage destruction caused by infection. As a result, cartilage-sparing otoplasty such as the Mustardé and Furnas types has been increasingly popular. However, postauricular suture extrusion may result, and recurrence rates of up to 25 percent have been recorded. In this study, cartilage-sparing otoplasty is refined by the addition of a postauricular fascial flap to reduce suture extrusion and recurrence rates. Fifty-one patients underwent otoplasty (45 bilateral, six unilateral). This technique involves the elevation of a fascial flap from the postauricular region. A new antihelical fold is then created by Mustardé sutures, and the conchal bowl is rotated by Furnas-type concha-mastoid sutures. The fascial flap is then advanced to cover the sutures with a supplementary vascularized layer to prevent suture extrusion. In addition, the advancement of the flap acts as a postauricular support to prevent recurrence. A natural-looking antihelical fold and helical rim is created by this technique. There were no hematomas. There was recurrence in eight ears (8 percent) in six patients. Two patients requested further surgery. No patients developed suture extrusion or granuloma. This is a simple and intrinsically safe procedure and does not cause irreparable complications such as anterior scarring or skin necrosis. The postauricular fascial flap seems to prevent suture extrusion. It may also help to reduce recurrence rates to acceptable levels.
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In the citing paper
“Other noncomparative cohorts describing a cartilage-sparing technique with a postauricular flap have reported similarly low incidences of extrusion ranging from 0% to 3%, as well as recurrence rates ranging from 0% to 8% of ears. 19,22-24,28”
In the citing paper
“Horlock et al83 highlighted that the fascial flap provided vascularized protection, reducing extrusion and recurrence rates, while preserving aesthetics.”
From Otoplasty Surgical Techniques and Clinical Outcomes: A Practical Review (2026) · cites this paper as [83]
In the citing paper
“Histologically, the vascularized fascia placed in this area functions as a non-epithelial buffer that separates the suture material from the overlying skin, thereby reducing the risk of extrusion and recurrence [15].”
From Comparative Analysis of Mustardé, Fascioperichondrial Flap, and Combined Otoplasty Techniques: Clinical Outcomes and Recurrence Rates in 365 Patients (2025) · cites this paper as [15]
In the citing paper
“To address these limitations, several supportive techniques have been introduced, with particular emphasis on the postauricular fascial flap and its variations (e.g., perichondrio-adipo-dermal flap and modified bilateral fascioperichondrial flap). These methods aim to reduce both recurrence and suture-related complications by providing a well-vascularized tissue barrier over the suture line [15,16”
From Comparative Analysis of Mustardé, Fascioperichondrial Flap, and Combined Otoplasty Techniques: Clinical Outcomes and Recurrence Rates in 365 Patients (2025) · cites this paper as [15]
In the citing paper
“In comparison to data found in publications of dorsal incision techniques, scar revision or correction (e.g., due to hypertrophic scaring) was of no higher frequency for our examined population (Figure 3) [20].”
From Otoplasty through Ventral Skin Incision and Shaping of the Antihelix by Abrasion—A Retrospective Study (2021) · cites this paper as [20]
In the citing paper
“Although the literature shows palpable or protruding suture knots to be a relevant complication, even leading to respective usage of flap techniques for knot coverage [20,21]”
From Otoplasty through Ventral Skin Incision and Shaping of the Antihelix by Abrasion—A Retrospective Study (2021) · cites this paper as [20]
In the citing paper
“In the current study, we used both medially and laterally based flaps, and found both to provide a robust vascularized layer of tissue covering the row of cartilage sutures, with no reported suture extrusion or relapse in any case.”
In the citing paper
“Several studies have modified cartilage-sparing otoplasty by including a postauricular fascial flap to cover the postauricular sutures. 17,19-30”
In the citing paper
“In 2001, a refined method incorporating Mustardé14 and Furnas15 sutures with a postauricular fascial flap achieved an 8% recurrence rate, with no suture extrusions or hematomas over a median follow-up of 19 months in 51 patients.83”
From Otoplasty Surgical Techniques and Clinical Outcomes: A Practical Review (2026) · cites this paper as [83]
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Vlahovic, A. M., & Haxhija, E. Q. (2017) · Springer eBooks · doi:10.1007/978-3-319-56004-5_2
Shokrollahi, K. (2022) · Aesthetic Surgery Journal · doi:10.1093/asj/sjac152
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Mandour, Y. M. H., & Abdelmofeed, A. M. (2023) · Acta Otorrinolaringologica (English Edition) · doi:10.1016/j.otoeng.2021.09.005
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Shawky, M. A., Shawky, M. A., Zaghloul, A. I., & Zakaria, N. Z. (2024) · Indian Journal of Otolaryngology and Head & Neck Surgery · doi:10.1007/s12070-024-04872-9
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Metadata
- Authors
- Horlock, N., Misra, A., & Gault, D. T.
- Affiliations
- Mount Vernon Hospital (GB)
- ORCID
- Misra, Alok
- Venue
- Plastic and Reconstructive Surgery
- Published
- 2001-11
- Volume
- 108
- Issue
- 6
- Pages
- 1487-1490
- ISSN
- 0032-1052 (ISSN-L)
- OpenAlex
- W2005444244
- Cited by
- 102
- References
- 14
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 7 · 2023: 3 · 2022: 6 · 2021: 3 · 2020: 6 · 2019: 7 · 2018: 11 · 2017: 4 · 2016: 6 · 2015: 2 · 2014: 4 · 2013: 13 · 2012: 7
- FWCI
- 0.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Plastic & Reconstructive Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Health Sciences › Medicine › Genetics (clinical) › Congenital Ear and Nasal Anomalies
- Keywords
- otoplasty, suture extrusion, recurrence, antihelical fold
- MeSH terms
- Adolescent, Adult, Aged, Child, Child, Preschool, Ear Cartilage, Ear, External, Female, Humans, Male, Middle Aged, Postoperative Complications, Surgical Flaps, Plastic Surgery Procedures
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