Aesthetic Ear Reconstruction

The loss of the soft tissue of the helical rim and the adjacent antihelical fold can present a significant deformity.  When patients exhibit ear wounds with exposed cartilage, restoration of the normal ear contour may be accomplished with a chondrocutaneous rotation flap¹.  In larger defects however, this technique may result in a noticeable decrease in pinna size.  For helical rim losses greater than 2.0 cm we have been performing a two-stage retro-auricular flap including placement of cartilage graft harvested from the contralateral conchal bowl when needed.  We describe our technique and present our results including complications.

The following modifications to existing techniques have helped improve the aesthetic results.  The flap is elevated starting on the posterior aspect of the pinna distal to the post-auricular sulcus so as to have a very thin flap of adequate length The flap is elevated in the immediate subdermal plane and thickened to the deep subcutaneous plane as the base of the pedicle is approached.  This creates a very thin flap and avoids blunting the contours of the exposed cartilage or the cartilage graft.  When a cartilage graft is needed, its leading edge is inserted under the intact antihelical cartilage and secured with horizontal mattress sutures to create a strong construct that can resist the forces of scar contraction.  A full thickness skin graft is usually needed to close the flap donor site at the time of division and inset.

 Between March 2007 and February 2013 we performed 25 ear reconstructions in 23 patients.  Eight reconstructions included replacement of missing cartilage.  The patient ages ranged from 10-83 years.   Patients were followed for at least 3 months.  24 reconstructions were for skin cancer and one was for trauma.  There was one partial flap and cartilage graft loss in an insulin-dependent diabetic patient and one skin graft loss.  Two patients developed local wound infections requiring oral antibiotics.  Three patients requested minor revisions.  All patients were ultimately satisfied with the natural-looking appearance of their reconstructed ear.  The two-staged retroauricular flap with or without cartilage graft restores the normal pinna contour without creating size asymmetry in larger defects of the helical rim and anti-helical fold.