Auricular, Preauricular, and Postauricular Skin Flaps to The External Auditory Canal
W. B. MACOMBER
J. D. NOONAN
Stenosis of the external auditory canal is an infrequent but serious consequence of congenital malformation, auricular trauma, or surgical extirpation. Even relatively minor scarring can cause marked functional and physical impairment. Not only is there a possibility of hearing deficit, but there is also the probability of chronic inflammation and infection.
INDICATIONS
The use of skin grafts may provide a temporary solution; however, late results have shown that the ongoing process of wound contraction invariably produces further reduction in the lumenal diameter. To rectify this problem, a variety of local flaps can be used to break up the concentric scarring (1, 2, 3, 4).
ANATOMY
The vascularity of these flaps is based on the rich dermal network that exists in this region arising from both the preauricular and postauricular vessels.
OPERATIVE TECHNIQUE
Conchal Skin Flap
This is an excellent choice, provided the auricular tissue has not been damaged by antecedent trauma. Based either inferiorly (Fig. 91.1) or superiorly, the entire conchal skin and subcutaneous tissue can be elevated and transposed across the meatus of the external auditory canal. Care must be taken not to denude the conchal cartilage of its perichondrium, and a relatively wide base ensures flap viability. The flap donor site is usually closed with a skin graft.
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