Preauricular Translobular Flap for Reconstruction of Auricular Defects

EDITORIAL COMMENT

Excellent technique for small flaps of the helix, providing full-thickness coverage, minimal scarring, and reasonably good color match. Exposed cartilage should be removed to avoid suppuration.

INDICATIONS

A preauricular skin flap tunneled through the ear lobule is a versatile method for coverage of exposed ear cartilage and reconstruction of full-thickness defects of the middle third of the helical rim. Many techniques for reconstructing partial- and full-thickness auricular defects acquired through tumor resection, infection, trauma, or burn injury have been described including skin grafts, chondrocutaneous flaps (1), two-stage retroauricular flaps with or without cartilage grafts (2, 3), composite chondrocutaneous graft (4, 5), or pedicled tube skin flaps (6). This flap allows for single-stage coverage of exposed or infected cartilage that would not support a skin graft or chondrocutaneous graft, and while reconstruction of midhelical defects of the ear is well accomplished through a chondrocutaneous flap technique, disadvantages include shortening of ear height and the potential for hematoma following dissociation of the helical flap from the conchoscaphal framework. The preauricular translobular flap has been employed in patients with midhelical rim defects due to radical resection of basal cell carcinoma and malignant melanoma with defects measuring as large as 4 cm long and 1 cm wide.

ANATOMY

The auricle and, in particular, the helical rim consist of a curved cartilage framework wrapped with thin skin. While some of the well-described techniques restore the anatomy with both skin and cartilage, the preauricular flap does not itself supply cartilage. Nevertheless, it will suffice to resurface partial-thickness defects with exposed cartilage, and it will provide an aesthetically excellent reconstruction of the full-thickness midhelical defect. Blood supply to the flap derives from the superficial temporal artery.

FLAP DESIGN AND DIMENSIONS

The flap is drawn in the preauricular skin, extending from the sideburn to the ear lobule, measuring 6 cm in length and 1.5 cm in width based in front of the ear lobule (Fig. 82.1). The design for the working part of the flap and its soon to
be de-epithelialized pedicle is demonstrated in the patient in Figure 82.1, who is undergoing radical resection of melanoma and sentinel lymph node biopsy.

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