eMedicine Specialties > Dermatology > Surgical

Ear Reconstruction: Multimedia

Author: Ken K Lee, MD, Associate Professor, Departments of Dermatology, Surgery, and Otolaryngology-Head and Neck Surgery, Director, Dermatologic and Laser Surgery, Oregon Health and Science University
Contributor Information and Disclosures

Updated: Nov 13, 2009

Multimedia

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Media file 1: Surface anatomy of the anterior (lateral) surface of the ear.

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Surface anatomy of the anterior (lateral) surface of the ear.

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Media file 2: Posterior (medial) surface of the ear. The skin is less adherent than that of the anterior surface.

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Posterior (medial) surface of the ear. The skin is less adherent than that of the anterior surface.

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Media file 3: Left image: Small defects on the helix can be closed with primary linear closures as long as the width of the defect is within the helix. Note the narrowing of the helix, which may not be ideal in certain locations. Right image: The incision may have to be lengthened to blend the narrowing of the helix.

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Left image: Small defects on the helix can be closed with primary linear closures as long as the width of the defect is within the helix. Note the narrowing of the helix, which may not be ideal in certain locations. Right image: The incision may have to be lengthened to blend the narrowing of the helix.

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Media file 4: Wedge excision repair. Panel A: Defect after cancer excision. Panel B: Wedge-shaped defect is created. Panel C: The helix is approximated. Panel D: Image shows the result immediately after surgery.

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Wedge excision repair. Panel A: Defect after cancer excision. Panel B: Wedge-shaped defect is created. Panel C: The helix is approximated. Panel D: Image shows the result immediately after surgery.

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Media file 5: If the defect in Image 4 were larger, Burrow triangles can be superiorly and inferiorly excised to create a star.

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If the defect in Image 4 were larger, Burrow triangles can be superiorly and inferiorly excised to create a star.

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Media file 6: Chondrocutaneous advancement flap. Panel A: A 2.5-cm defect is present on the helix. Panel B: Another view of the defect. Panel C: Undermining and lifting of the posterior skin off the perichondrium. Panel D: Immediate postoperative view.

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Chondrocutaneous advancement flap. Panel A: A 2.5-cm defect is present on the helix. Panel B: Another view of the defect. Panel C: Undermining and lifting of the posterior skin off the perichondrium. Panel D: Immediate postoperative view.

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Media file 7: Chondrocutaneous advancement flap. Panel E: Immediate postoperative view. Panel F: Anterior surface at 2 months after surgery. Panel G: Posterior surface at 2 months after surgery.

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Chondrocutaneous advancement flap. Panel E: Immediate postoperative view. Panel F: Anterior surface at 2 months after surgery. Panel G: Posterior surface at 2 months after surgery.

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Media file 8: Banner transposition flap. Panel A: The preauricular skin is used as the donor site of the flap. Panel B: The flap is lifted and draped into the defect. Panels C and D: Immediate postoperative views.

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Banner transposition flap. Panel A: The preauricular skin is used as the donor site of the flap. Panel B: The flap is lifted and draped into the defect. Panels C and D: Immediate postoperative views.

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Media file 9: Bilobed transposition flap. Panels A and B: A 2-cm defect on the superior helix. Panel C: Outline of the classic bilobed flap with 90° between the pedicles. Panel D: The flap is cut with a modified bilobed flap with a relatively small turning radius.

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Bilobed transposition flap. Panels A and B: A 2-cm defect on the superior helix. Panel C: Outline of the classic bilobed flap with 90° between the pedicles. Panel D: The flap is cut with a modified bilobed flap with a relatively small turning radius.

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Media file 10: Bilobed transposition flap. Panels E and F: Immediate postoperative views. Panel G: Anterior surface at 1 month after surgery.

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Bilobed transposition flap. Panels E and F: Immediate postoperative views. Panel G: Anterior surface at 1 month after surgery.

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Media file 11: O-to-T advancement flap. Panel A: Defect with incisions lines marked. Panel B: Immediate postoperative view. Panel C: Immediate postoperative view of the anterior surface. Panel D: Posterior surface at 1 month after surgery.

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O-to-T advancement flap. Panel A: Defect with incisions lines marked. Panel B: Immediate postoperative view. Panel C: Immediate postoperative view of the anterior surface. Panel D: Posterior surface at 1 month after surgery.

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Media file 12: O-to-T advancement flap. Anterior surface 1 month after surgery.

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O-to-T advancement flap. Anterior surface 1 month after surgery.

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Media file 13: Skin graft. Panel A: Conchal defect with the cartilage removed. Panel B: Split-thickness skin graft in place. Panel C: Split-thickness skin graft at 1-month follow-up.

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Skin graft. Panel A: Conchal defect with the cartilage removed. Panel B: Split-thickness skin graft in place. Panel C: Split-thickness skin graft at 1-month follow-up.

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Media file 14: Second intention healing. Panel A: Postoperative defect with exposed cartilage. Panel B: Holes punched through the cartilage expose the undersurface of the posterior skin.

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Second intention healing. Panel A: Postoperative defect with exposed cartilage. Panel B: Holes punched through the cartilage expose the undersurface of the posterior skin.

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Media file 15: Second intention healing. Wound healing by second intention at 1-month follow-up.

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Second intention healing. Wound healing by second intention at 1-month follow-up.

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Media file 16: Preauricular advancement. Panel A: Defect on the helical root, the tragus, and the preauricular sulcus. Panel B: Cheek advancement into the face-lift line.

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Preauricular advancement. Panel A: Defect on the helical root, the tragus, and the preauricular sulcus. Panel B: Cheek advancement into the face-lift line.

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Media file 17: Postauricular sulcus defect. Panel A: Large defect straddling the postauricular defect. Panel B: The defect is reapproximated with a single layer of modified vertical mattress sutures. Panel C: Posterior surface at 1 month after surgery.

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Postauricular sulcus defect. Panel A: Large defect straddling the postauricular defect. Panel B: The defect is reapproximated with a single layer of modified vertical mattress sutures. Panel C: Posterior surface at 1 month after surgery.

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Media file 18: Postauricular sulcus defect in the same patient as in Image 17. Panel D: Anterior surface at 1 month after surgery. Panel E: Symmetry, as depicted in the posterior view at 1 month after surgery. Panel F: Symmetry, as depicted in the anterior view at 1 month after surgery.

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Postauricular sulcus defect in the same patient as in Image 17. Panel D: Anterior surface at 1 month after surgery. Panel E: Symmetry, as depicted in the posterior view at 1 month after surgery. Panel F: Symmetry, as depicted in the anterior view at 1 month after surgery.

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Media file 19: Modified vertical mattress sutures. Panel A: The needle is passed through fascia at the base of the sulcus. Panel B: Completion of one vertical mattress suture. Panel C: The sutures are tied after all of them are in place.

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Modified vertical mattress sutures. Panel A: The needle is passed through fascia at the base of the sulcus. Panel B: Completion of one vertical mattress suture. Panel C: The sutures are tied after all of them are in place.

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Media file 20: Panel A: Defect on the lobule. Panel B: Primary closure of lobule defect with full-thickness wedge excision.

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Panel A: Defect on the lobule. Panel B: Primary closure of lobule defect with full-thickness wedge excision.

More on Ear Reconstruction

Overview: Ear Reconstruction

Treatment: Ear Reconstruction

Follow-up: Ear Reconstruction

Multimedia: Ear Reconstruction

References

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References

Miller DL, Weinstock MA. Nonmelanoma skin cancer in the United States: incidence. J Am Acad Dermatol. May 1994;30(5 Pt 1):774-8. [Medline].
Katzbach R, Frenzel H, Klaiber S, et al. Borderline indications for ear reconstruction. Ann Plast Surg. Dec 2006;57(6):626-30. [Medline].
Tolleth H. Artistic anatomy, dimensions, and proportions of the external ear. Clin Plast Surg. Jul 1978;5(3):337-45. [Medline].
Salasche SJ, Bernstein G, Senkarik M. Surgical Anatomy of the Skin. Norwalk, Conn: Appleton & Lange;1988:217-21.
Brent B. The acquired auricular deformity. A systematic approach to its analysis and reconstruction. Plast Reconstr Surg. Apr 1977;59(4):475-85. [Medline].
Quatela V, Cheney M. Reconstruction of the auricle. In: Baker SR, Swanson NA, eds. Local Flaps in Facial Reconstruction. St. Louis: Mosby-Year Book;1995:443-79.
Antia NH, Buch VI. Chondrocutaneous advancement flap for the marginal defect of the ear. Plast Reconstr Surg. May 1967;39(5):472-7. [Medline].
Brent B. Reconstruction of the ear. In: Aston SJ, Beasley RW, Thorne CH, eds. Grabb and Smith's Plastic Surgery. 5^th ed. Philadelphia: Lippincott-Raven; 1997:413-29.
Crikelair GF. A method of partial ear reconstruction for avulsion of the upper portion of the ear. Plast Reconstr Surg (1946). Jun 1956;17(6):438-43. [Medline].
Lawson VG. Reconstruction of the pinna using pre-auricular flaps. J Otolaryngol. Jun 1984;13(3):191-3. [Medline].
D'Arpa S, Cordova A, Moschella F. Further application of the bilobed flap: the split bilobed flap for reconstruction of composite posterior auricular and mastoid defects. J Plast Reconstr Aesthet Surg. 2006;59(12):1330-5. [Medline].
Zitelli JA. The bilobed flap for nasal reconstruction. Arch Dermatol. Jul 1989;125(7):957-9. [Medline].
Wines N, Ryman W, Matulich J, Wines M. Retrospective review of reconstructive methods of conchal bowl defects following mohs micrographic surgery. Dermatol Surg. May 2001;27(5):471-4. [Medline].

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Keywords

ear reconstruction, helical defects, helix defects, primary linear repair, wedge excision repair, chondrocutaneous advancement flap, banner transposition flap, bilobed flap, O to T advancement flap, anterior surface defects, preauricular sulcus defects, postauricular sulcus defects, lobule defects, skin cancer excision, defects on the ear, skin cancer

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Contributor Information and Disclosures

Author

Ken K Lee, MD, Associate Professor, Departments of Dermatology, Surgery, and Otolaryngology-Head and Neck Surgery, Director, Dermatologic and Laser Surgery, Oregon Health and Science University
Ken K Lee, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, and American Society for Dermatologic Surgery
Disclosure: Nothing to disclose.

Medical Editor

Shobana Sood, MD, Assistant Professor, Department of Dermatology, University of Pennsylvania Hospital
Shobana Sood, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Dermatologic Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

John G Albertini, MD, Consulting Staff, Dermatologic Surgery, The Skin Surgery Center; Program Director, ACGME accredited Fellowship in Procedural Dermatology
John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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eMedicine Specialties > Dermatology > Surgical

Ear Reconstruction: Multimedia

Multimedia

Surface anatomy of the anterior (lateral) surface of the ear.

Posterior (medial) surface of the ear. The skin is less adherent than that of the anterior surface.

Wedge excision repair. Panel A: Defect after cancer excision. Panel B: Wedge-shaped defect is created. Panel C: The helix is approximated. Panel D: Image shows the result immediately after surgery.

If the defect in Image 4 were larger, Burrow triangles can be superiorly and inferiorly excised to create a star.

Chondrocutaneous advancement flap. Panel A: A 2.5-cm defect is present on the helix. Panel B: Another view of the defect. Panel C: Undermining and lifting of the posterior skin off the perichondrium. Panel D: Immediate postoperative view.

Chondrocutaneous advancement flap. Panel E: Immediate postoperative view. Panel F: Anterior surface at 2 months after surgery. Panel G: Posterior surface at 2 months after surgery.

Banner transposition flap. Panel A: The preauricular skin is used as the donor site of the flap. Panel B: The flap is lifted and draped into the defect. Panels C and D: Immediate postoperative views.

Bilobed transposition flap. Panels A and B: A 2-cm defect on the superior helix. Panel C: Outline of the classic bilobed flap with 90° between the pedicles. Panel D: The flap is cut with a modified bilobed flap with a relatively small turning radius.

Bilobed transposition flap. Panels E and F: Immediate postoperative views. Panel G: Anterior surface at 1 month after surgery.

O-to-T advancement flap. Panel A: Defect with incisions lines marked. Panel B: Immediate postoperative view. Panel C: Immediate postoperative view of the anterior surface. Panel D: Posterior surface at 1 month after surgery.

O-to-T advancement flap. Anterior surface 1 month after surgery.

Skin graft. Panel A: Conchal defect with the cartilage removed. Panel B: Split-thickness skin graft in place. Panel C: Split-thickness skin graft at 1-month follow-up.

Second intention healing. Panel A: Postoperative defect with exposed cartilage. Panel B: Holes punched through the cartilage expose the undersurface of the posterior skin.

Second intention healing. Wound healing by second intention at 1-month follow-up.

Preauricular advancement. Panel A: Defect on the helical root, the tragus, and the preauricular sulcus. Panel B: Cheek advancement into the face-lift line.

Postauricular sulcus defect. Panel A: Large defect straddling the postauricular defect. Panel B: The defect is reapproximated with a single layer of modified vertical mattress sutures. Panel C: Posterior surface at 1 month after surgery.

Postauricular sulcus defect in the same patient as in Image 17. Panel D: Anterior surface at 1 month after surgery. Panel E: Symmetry, as depicted in the posterior view at 1 month after surgery. Panel F: Symmetry, as depicted in the anterior view at 1 month after surgery.

Modified vertical mattress sutures. Panel A: The needle is passed through fascia at the base of the sulcus. Panel B: Completion of one vertical mattress suture. Panel C: The sutures are tied after all of them are in place.

Panel A: Defect on the lobule. Panel B: Primary closure of lobule defect with full-thickness wedge excision.

More on Ear Reconstruction

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor