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Cryptotia is a congenital ear deformity characterized by the upper helix buried under the skin of the temporal region. Recurrence and inadequate correction of ear position are major complications following auricle reconstruction. Abnormalities of the auricular muscles are closely associated with cryptotia and considered to be the main cause. However, current corrective procedures focus on provision of additional skin and abnormal auricular muscle correction is considered supplementary. We report a surgical approach focused on the anatomical repositioning of the external auricular muscle insertions and skin cover with a mini flap. Two consecutive patients aged 6 and 14 years with mild cryptotia (minimal auricular cartilage deformity) were treated using this technique with a follow-up duration of 12-25 months. The abnormal insertion of the superior auricular muscle (SAM) to the superior helix was repositioned to its correct anatomical position below the eminence of the triangular fossa, effectively moving the ear posterosuperiorly. No complications occurred postoperatively, the increase in vertical length of the superior helix to the superior ear attachment was 7.8 and 7.9 mm at 6months. Both patients could wear facemasks comfortably without them sliding off and were satisfied with the esthetic results. Total follow-up duration was 3 years in Case 1 and 4.4 years in Case 2. Primary correction of the SAM to its anatomical position may be a useful method for reducing the size of the skin flaps required with minimal donor site morbidity in reconstruction of mild cryptotia., Competing Interests: None., (© 2023 The Authors.)

Objective: Negative Pressure Wound Therapy (NPWT) is increasingly being used as a major method of skin graft dressing and fixation. Negative Pressure Wound Therapy with Instillation and Dwelling (NPWTi-d) further enhances wound care over regular NPWT. However, only a few reports have been made on its use for skin graft fixation due to concerns of graft maceration or detachment. We used NPWTi-d to fix skin grafts for 4 cases of severely contaminated complex posttraumatic wounds., Methods: The age ranged from 37 to 72 years, and included trauma of the lower leg, forearm dog bite and incomplete amputations of the upper arm and hand respectively. The mean instillation saline volume per wound size was 0.21 ml/cm 2 and the dwelling time reduced to 3 min. The NPWTi-d skin graft fixation was removed after about a week., Results: All the grafts healed well and no complications such as infection or contracture were observed. Follow-up time was 1 -8 months., Conclusions: NPWTi-d may be a useful option for fixing skin grafts particularly in contaminated wounds with a high risk of infection., Competing Interests: None., (© 2022 The Authors.)