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Ear Reconstruction after Mohs Cancer Excision: Lessons Learned from 327 Consecutive Cases

Sanniec, Kyle M.D., M.H.A.; Harirah, Muhammad B.A.; Thornton, James F. M.D.

Plastic and Reconstructive Surgery: September 2019 - Volume 144 - Issue 3 - p 719-729
doi: 10.1097/PRS.0000000000005992
Reconstructive: Head and Neck: Original Articles
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Coding Perspective

Background: The ear serves many functional and aesthetic purposes, and its complex structure presents a notable challenge for reconstruction. A paucity of objective data and analysis on reconstruction of acquired ear defects remains. The goal of this study was to evaluate all ear reconstructions and the lessons learned over the past decades in treating these complicated defects in a large clinical Mohs reconstruction practice.

Methods: A retrospective analysis of consecutive patients who underwent ear reconstruction after Mohs cancer excision from 2004 to 2018 performed by the senior author (J.F.T) was conducted. Data regarding patient demographics, oncologic type, treatment, defect characteristics, reconstructive modalities, number of stages, and complications were collected and analyzed.

Results: Three hundred twenty-seven patients underwent ear reconstruction. Defects most commonly involved the superior one-third of the helix and the antihelix. Approximately half of the patients’ defects were reconstructed with full-thickness skin grafts, and approximately one-third of the patients’ defects required flap reconstruction. There were 30 complications (9 percent), ranging from partial flap loss to cancer recurrence. There was no difference in complication rates in elderly patients compared with the younger cohort.

Conclusions: Optimizing results when reconstructing ear defects is challenging, and there are multiple preoperative variables to consider. Ear reconstruction is safe in an outpatient setting, and age should not preclude patients from undergoing reconstruction of ear defects. The lessons learned from the past decade of ear reconstructions are demonstrated, and an algorithmic approach to treating these defects allows for a safe and reproducible method for reconstructing acquired ear defects.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Coding Perspective for this Article is on Page 728.

Dallas, Texas

From the Department of Plastic Surgery, University of Texas Southwestern.

Received for publication June 30, 2018; accepted January 4, 2019.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

James F. Thornton, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390, james.thornton@utsouthwestern.edu

Copyright © 2019 by the American Society of Plastic Surgeons