Ear reconstruction - Superior helix
Considerations
Cosmesis
The hair may cover the deformity, so reconstruct form based on the patient's individual needs
Function
If the patient wears glasses, you must restore the structural framework
Reconstructive options based on the defect
Very small with intact cartilage
Secondary intention
Primary closure
Skin graft
Local skin advancement
Small defects (<1.5 cm) of the helix and antihelix
Convert to wedge-shaped full-thickness excision with primary closure
Larger small defects may require a star extension of the wedge
Medium-sized defects and defects limited to the helical rim up to 2 cm
Helical chondrocutaneous advancement flaps
Banner transposition flap +/- cartilage graft
Composite grafts from the contralateral ear
Large defects (greater than 2.5 cm)
Bipedicled tubed flaps
Very large
Combination of temporoparietal fascial flap (TPFF), cartilage graft, skin graft
Chondrocutaneous conchal flap with skin graft
Combination of local flaps - chondrocutaneous flap and postauricular skin flap
If full-thickness defect, add postauricular transposition skin flap
Peninsular conchal axial flap
Ascending helix free flap from the opposite ear
For defects sparing the rim
Postauricular subcutaneous pedicled advancement flap
Island chondrocutaneous postauricular flap (aka auricular rotation flap, flip-flop flap, revolving door flap, and postauricular myocutaneous island flap)
Literature
Preparation
Procedure
Sample operative report