Commentary on: Utilization of Free Soft Tissue Grafts in Otoplasty: A Simple Yet Effective Way to Avoid Suture Extrusion

See the Original Article here. The authors have summarized their experience from over 200 cases relating to soft-tissue interposition between postauricular skin and suture knots in suture-based otoplasty.1 Suture extrusion is one of the most common complications in procedures that utilize concho-mastoid or concho-scaphal sutures. Therefore, any intervention that reduces this complication should be seriously considered. As a prelude to the merits of their paper, we need to understand the context. Firstly, and in very general terms, the 2 main schools of otoplasty have followed the paths of cartilage cutting—anterior scoring—and variations on this theme originally described by Chong-Chet, or suture-based techniques utilizing sutures positioned to re-create the antihelical fold described by Mustarde and to rotate the conchal bowl and reduce its prominence as described by Furnas.1-3 It should be noted that the authors have overstepped the mark somewhat by describing anterior scoring techniques and their variations as having “unacceptably high” levels of complications.4-6 Importantly, one large analysis of 500 consecutive cases from the author’s own country had demonstrated anterior scoring techniques in the right hands to be highly effective, with high patient satisfaction of 95% and with low complications: “There were no infections or ear necrosis. A small cutaneous wound was present on the anterior skin in 3 patients (0.6%), and there was one wound dehiscence (0.2%). Late complications were keloids in 2 cases and inclusion cysts in three cases. Residual deformity was noted in 22 cases and asymmetry in 28 cases. Secondary surgery was performed in 6 cases.” 7