A minimally invasive modified revolving-door flap for surgical reconstruction of concha and antihelix defects

Abstract

Skin cancers affecting the concha and antihelix are quite common, because of anterior auricular projection from the head and subsequent actinic exposure, leading to the need for effective ear reconstruction post-surgery. Various methods such as skin grafts, free tissue transplantation, and local flaps have been used. This study introduces a refined technique for concha-antihelix defect reconstruction, based on a minimally invasive modification of the revolving-door flap procedure. Here, a fasciocutaneous flap technique involving minimal posterior auricular muscle contribution is used, particularly suitable for anterior skin and cartilage defects. The study included 75 patients with nonmelanocytic skin carcinoma on the ear's anterior surface, in which we evaluated patient's and surgeon's satisfaction with a visual analogue scale and discussed the surgical technique and its advantages and indications. The technique demonstrated excellent cosmetic and functional outcomes, effectively hiding donor-site deformities and ensuring patient and surgeon contentment. This approach allows for one-stage reconstruction under local anesthesia, reducing costs, surgery time, and recovery period. The procedure provides high-quality tissue for reconstruction with low complication risks, making it an optimal choice for wide conchal and antihelix defect repairs due to its proximity to the affected area and the reliable, swift nature of the method.