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 

  • 2011: Partial Auricular Reconstruction

Preparation

Procedure

Sample operative report

Post-op

Pearls & Pitfalls

High-Yield

Links

• eMedicine - Dermatologic Approach to Ear Reconstruction Treatment & Management

• eMedicine - Ear Reconstruction and Salvage Procedures Treatment & Management

• UTMB - Auricular Reconstruction

• UTMB - Otoplasty & Other Techniques of Auricular Reconstruction