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measuring 13<span class="elsevierStyleHsp" style=""></span>mm in its largest diameter&#44; submitted to Mohs micrographic surgery &#40;MMS&#41; and removed in the first stage&#46; The second patient had an infiltrative basal cell carcinoma &#40;BCC&#41;&#44; measuring 8<span class="elsevierStyleHsp" style=""></span>mm in its largest diameter&#44; removed in 2 stages&#44; using MMC&#46; Finally&#44; the third case was a well-differentiated SCC&#44; measuring 10<span class="elsevierStyleHsp" style=""></span>mm in its largest diameter&#44; resected using the conventional technique &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Surgical planning is essential to attain good results in the management of tumors in the auricular region&#46; Among its peculiarities&#44; a significant amount of cartilage is present which may not resist distortions secondary to scar contracture&#46; Additionally&#44; there is an increased risk of necrosis due to the thinness of the auricular skin&#46; In the case of the helix&#44; the choice of repair is based on the location&#44; size of the defect&#44; and the amount of cartilage loss&#46; Small defects &#40;&#60;1&#8210;1&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#41; are easily reconstructed with wedge excision and primary closure&#44; unlike larger defects&#44; which require the use of grafts or flaps&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Grafts require a preserved cartilaginous structure&#44; with viable perichondrium or cartilage perforations to allow irrigation through the contralateral bed&#46; In composite defects&#44; the structural loss of the helix margin requires cartilage and skin for its repair&#44; which can be performed using the following techniques&#58; composite graft from the contralateral auricle&#59; interpolated flaps using cartilage&#59; chondrocutaneous flap&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#8211;5</span></a> The latter is frequently used and can be performed through a skin incision on only one surface of the ear and cartilage&#44; as described by Antia and Buch&#44; or through a full-thickness incision including the skin of the two surfaces and cartilage &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The chondrocutaneous flap was first described by Antia and Buch&#44; in 1967&#46; The principle of the procedure is to advance the skin and cartilage of the intact portion of the helix adjacent to the defect&#44; based on a wide and secure retroauricular pedicle&#44; with greater preservation of the vascularization of the posterior auricular artery&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However&#44; the classic technique has lost prominence since the initial report and several modifications have been made &#8210; including the incision of the transition line from the helix to the dorsum of the ear&#44; limiting irrigation by restricting the pedicle to the lower portion of the flap only&#44; which carries the risk of local vascularization impairment&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Therefore&#44; Antia and Buch flap&#44; despite having been described more than 50 years ago&#44; maintains its role among the techniques of helix reconstruction&#44; and its knowledge is important for dermatological surgeons&#46; It is an effective and safe method&#44; performed in a single step with the additional advantage of preserving local vascularization&#44; reducing the risk of necrosis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0095" class="elsevierStylePara elsevierViewall">Paula Hitomi Sakiyama&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Thiago Augusto Ferrari&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Ra&#237;ssa Rigo Garbin&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; collection&#44; analysis&#44; and interpretation of data&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Roberto Gomes Tarl&#233;&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Case Letter
Old but gold – Antia and Buch chondrocutaneous advancement flap for helical reconstruction: a series of cases
Paula Hitomi Sakiyamaa,
Autor para correspondência
paulasakiyama@gmail.com

Corresponding author.
, Thiago Augusto Ferraria, Raíssa Rigo Garbina, Roberto Gomes Tarléa,b
a Department of Dermatology, Hospital Santa Casa de Curitiba, Curitiba, PR, Brazil
b Discipline of Dermatology, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0060" class="elsevierStylePara elsevierViewall">The auricle or pinna is a frequent target of malignant neoplasms&#46; Half of the tumors are located in the helix&#44; and many defects involve both skin and cartilage&#44; making surgical reconstruction a challenge&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In this article&#44; the authors describe three cases of skin neoplasms in the helix repaired with Antia and Buch chondrocutaneous advancement flap&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> describes step-by-step the technique&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The first patient presented an <span class="elsevierStyleItalic">in situ</span> squamous cell carcinoma &#40;SCC&#41;&#44; measuring 13<span class="elsevierStyleHsp" style=""></span>mm in its largest diameter&#44; submitted to Mohs micrographic surgery &#40;MMS&#41; and removed in the first stage&#46; The second patient had an infiltrative basal cell carcinoma &#40;BCC&#41;&#44; measuring 8<span class="elsevierStyleHsp" style=""></span>mm in its largest diameter&#44; removed in 2 stages&#44; using MMC&#46; Finally&#44; the third case was a well-differentiated SCC&#44; measuring 10<span class="elsevierStyleHsp" style=""></span>mm in its largest diameter&#44; resected using the conventional technique &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Surgical planning is essential to attain good results in the management of tumors in the auricular region&#46; Among its peculiarities&#44; a significant amount of cartilage is present which may not resist distortions secondary to scar contracture&#46; Additionally&#44; there is an increased risk of necrosis due to the thinness of the auricular skin&#46; In the case of the helix&#44; the choice of repair is based on the location&#44; size of the defect&#44; and the amount of cartilage loss&#46; Small defects &#40;&#60;1&#8210;1&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#41; are easily reconstructed with wedge excision and primary closure&#44; unlike larger defects&#44; which require the use of grafts or flaps&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Grafts require a preserved cartilaginous structure&#44; with viable perichondrium or cartilage perforations to allow irrigation through the contralateral bed&#46; In composite defects&#44; the structural loss of the helix margin requires cartilage and skin for its repair&#44; which can be performed using the following techniques&#58; composite graft from the contralateral auricle&#59; interpolated flaps using cartilage&#59; chondrocutaneous flap&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#8211;5</span></a> The latter is frequently used and can be performed through a skin incision on only one surface of the ear and cartilage&#44; as described by Antia and Buch&#44; or through a full-thickness incision including the skin of the two surfaces and cartilage &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The chondrocutaneous flap was first described by Antia and Buch&#44; in 1967&#46; The principle of the procedure is to advance the skin and cartilage of the intact portion of the helix adjacent to the defect&#44; based on a wide and secure retroauricular pedicle&#44; with greater preservation of the vascularization of the posterior auricular artery&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However&#44; the classic technique has lost prominence since the initial report and several modifications have been made &#8210; including the incision of the transition line from the helix to the dorsum of the ear&#44; limiting irrigation by restricting the pedicle to the lower portion of the flap only&#44; which carries the risk of local vascularization impairment&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Therefore&#44; Antia and Buch flap&#44; despite having been described more than 50 years ago&#44; maintains its role among the techniques of helix reconstruction&#44; and its knowledge is important for dermatological surgeons&#46; It is an effective and safe method&#44; performed in a single step with the additional advantage of preserving local vascularization&#44; reducing the risk of necrosis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0095" class="elsevierStylePara elsevierViewall">Paula Hitomi Sakiyama&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Thiago Augusto Ferrari&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Ra&#237;ssa Rigo Garbin&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; collection&#44; analysis&#44; and interpretation of data&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Roberto Gomes Tarl&#233;&#58; Approval of the final version of the manuscript&#59; design and planning of the study&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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                  \t\t\t\t"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#41;</span><p id="par0010" class="elsevierStylePara elsevierViewall">Demarcation of the surgical margin</p></li></ul>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#41;</span><p id="par0015" class="elsevierStylePara elsevierViewall">Local anesthesia and lesion excision</p></li></ul>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#41;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Drawing of the flap&#44; showing a line at the limit anterior to the helix&#44; inferior to the defect&#44; extending to the lobe&#44; and the retroauricular compensation triangle</p></li></ul>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#41;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Linear incision on the anterior surface of the ear&#44; along the helix curvature up to the lobe&#44; including the cartilage&#44; without transfixing the retroauricular skin&#46; A compensation triangle can be drawn on the lobe</p></li></ul>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#41;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Retroauricular detachment over the cartilage with blunt scissors &#40;flap pedicle&#41;</p></li></ul>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#41;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Hemostasis</p></li></ul>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Chondrocutaneous flap advancement through the cartilage suture</p></li></ul>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Resection of the retroauricular compensation triangle</p></li></ul>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><ul class="elsevierStyleList" id="lis0050"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10&#41;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Suture of the skin</p></li></ul>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><ul class="elsevierStyleList" id="lis0055"><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">11&#41;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Compressive dressing</p></li></ul>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                    0 => array:2 [
                      "titulo" => "Ear Reconstruction after Mohs Cancer Excision&#58; Lessons Learned from 327 Consecutive Cases"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Sanniec"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46;H&#46; Antia"
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                      "doi" => "10.1097/00006534-196705000-00006"
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                      "titulo" => "Helical Rim Reconstruction with Chondrocutaneous Hatchet Flap-Z Plasty"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Dur&#287;un"
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                    0 => array:2 [
                      "doi" => "10.1097/SAP.0000000000001774"
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                        "tituloSerie" => "Ann Plast Surg"
                        "fecha" => "2019"
                        "volumen" => "82"
                        "paginaInicial" => "533"
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                      "titulo" => "Reconstruction of marginal ear defects with modified chondrocutaneous helical rim advancement flaps"
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        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0120" class="elsevierStylePara elsevierViewall">The authors would like to thank Kellen Cristina Ferrari Bana for making the drawings and Dr&#46; Gerson Dellatorre for suggestions and critical review of the manuscript&#46;</p>"
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