Chondrocutaneous Advancement Flap to The Helical Rim
N. H. ANTIA
This is an excellent procedure for restoring substantial defects of up to 3 cm of the helix of the ear. It gives predictably good results. Its only drawback is the lowering of the height of the ear. A good portion of the scar line is not as obvious as noted in the postoperative photographs, when the incision is placed within the helical sulcus (see diagrams).
Many acquired defects of the ear involve small segments of the helical margin, usually less than a quarter of the circumference of the ear. Such defects commonly result from the excision of tumors such as basal cell carcinoma or burns. Although small, the defect is very noticeable, especially in men. The chondrocutaneous advancement flap is a relatively simple and safe single-staged operative procedure that provides an almost normal contour to the ear (1, 2).
Several techniques have been described for the correction of helical defects, such as postauricular, cervical, or mastoid flaps or composite grafts. To correct such a defect and produce a good cosmetic result is difficult because of the intricate nature of the chondrocutaneous sandwich that gives the delicate configuration to the auricle.
The chondrocutaneous advancement flap recreates the normal delicate contours of the ear that are difficult to achieve by any other procedure. There is also no donor defect.
FLAP DESIGN AND DIMENSIONS
The principle underlying this procedure is that of advancement of the adjacent intact helical margin as a chondrocutaneous flap based on a wide postauricular skin pedicle. The ear lobule, which can be quite variable in size, is also advanced upward with this procedure.
If the defect is large, involving 3 to 4 cm of the helix, a double chondrocutaneous advancement of the helix can be performed by including the intact cephalic segment of the helix as a second flap (Fig. 83.1). It is important to extend the triangular tail of this flap right into the depth of the concha so that even after advancement the pleasing question mark shape of the helix is preserved. When such a large defect is closed by this technique (as shown in Fig. 83.2), it is often necessary to reduce the size of the contralateral ear to provide earlobe symmetry.