Key notes on plastic surgery/Adrian M. Richards

3
156 THE HEAD AND NECK
Suture techniques
Concha–mastoid sutures
• These sutures pass between the cartilage of the posterior aspect of the conchal
fossa and the fascia overlying the mastoid process.
• They pull the conchal fossa towards the head reducing the prominence of the
ear.
Mustardé sutures
• These mattress sutures pass through the cartilage of the scaphoid and conchal
fossas.
• They increase the degree of antihelical folding.
Fossa-fascia sutures
• These mattress sutures pass between the scaphoid fossa and the temporal fascia.
• They are primarily used to correct prominence of the upper part of the ear.
Excisional techniques
Skin excision alone
• Excision of posterior skin without correction of the cartilagenous defect almost
inevitably results in recurrence of the deformity.
• The following patterns of skin excision can be used to correct a prominent
lobule.
• Incorporating a fish-tail pattern at the lower end of the posterior skin
incision.
• Making a transverse incision, which is then closed vertically, on the posterior
aspect of the lobule.
Excision of a portion of conchal fossa
• Conchal fossa excisions alone can be used in patients with:
• Deep conchal fossas
• Normal antihelical folds.
• Conchal fossa excision may be performed through an anterior or posterior
incision.
Cartilage moulding techniques
• Cartilage moulding can be performed by:
• Open scoring after exposure of the cartilage.
• Closed techniques in which the cartilage is scored through a small anterior or
posterior skin incision.
• Both techniques rely on the Gibson principle which states that cartilage bends
away from a scored surface.
• The moulded cartilage can be secured in its new position with sutures.