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Reconstructing a Large Helical Rim Defect: Synergy of a Postauricular Perforator Flap, Diced Cartilage, and Otoplasty Technique

Kang, Gavin Chun-Wui MBBS, MRCSEd, MMed(Surg), MEng; Wu, Yijun MBBS, MRCSEd; Naidu, Shenthilkumar MBBS, MRCSEd, MMed(Surg), FAMS(Plastic Surgery); Lee, Shu Jin MBBS, MRCSEd, MMed(Surg), MD(Melb), FAMS(Plastic Surgery)

doi: 10.1097/SAP.0b013e31826cac47
Head and Neck Surgery

Abstract: Large full thickness helical ear defects are a challenge to reconstruct. A 25-year-old woman presented to us with loss of a large portion of the helical rim after an assault. A successful 2-stage reconstruction was performed, incorporating the principles of perforator flaps, otoplasty techniques, and use of diced cartilage more commonly used for rhinoplasty. There was a 5 × 0.5-cm central helical defect of the right ear. In the first stage, the original defect was recreated and a 7 × 1.5-cm inferiorly based postauricular artery perforator flap was raised from the right postauricular sulcus. Diced cartilage was harvested from the adjacent conchal bowl and conchomastoid sutures were used to set the relatively prominent ear back so as to facilitate tension-free donor-site closure. Diced cartilage was wrapped in the deep fascia of the perforator flap and the edges of the deep fascia were sutured to the perichondrium of the exposed cartilage. The pedicle was divided at a second stage. At 1-year postoperation, the reconstructed ear maintained good form and symmetry, and the patient was satisfied with the outcome. This is a novel efficient technique of reconstructing large ear helical defects combining a postauricular artery perforator flap with wrapped diced cartilage augmentation, and incorporating classical otoplasty technique for virtually scarless donor-site closure.

From the Department of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital, Singapore.

Received March 28, 2012, and accepted for publication, after revision, July 31, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Gavin Chun-Wui Kang, MBBS, MRCSEd, MMed(Surg), MEng, Department of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074. E-mail: gavinkangcw@yahoo.com.

© 2014 by Lippincott Williams & Wilkins