A versatile flap for reconstruction of partial pinna defects – The preauricular flap

Abstract

BackgroundSkin cancer very frequently involves the pinna, as this part of the body is vulnerably exposed to sun. Reconstructive options following excision are few due to hair bearing skin around. The most common method is a full thickness skin graft. There are flaps described from the posterior aspect of the ear1–3 for helical and conchal defects. The author describes various ways in which the preauricular flap4 can be used for the reconstruction of defects involving the medial anterior aspect of the pinna from the helix to the ear lobe. Patients and methodsDefects of the pinna resulting from resection of skin tumours which were situated along the anterior medial aspect were reconstructed using the preauricular flap. This flap was used to reconstruct 2 superior helical defects, 2 defects involving the tragal notch and external auditory canal, a defect involving the concha and for reconstruction of lobule of ear. ResultsReconstructions performed using the preauricular flap gave excellent results in terms of colour match, volume and appearance. Helical reconstruction with this flap following excision of cartilage and skin, provided the bulk required to mimic the fold. Ear lobe reconstruction results were good, with the provision of further improvement with the use of a cartilage between the layers. In tragal notch and external auditory canal, the preauricular flap sits snug giving a good contour. There were no flap failures or partial necrosis. The donor site scar is very well concealed as in a rhytidectomy. ConclusionsThe preauricular flap is a versatile flap which can be used for reconstruction of partial pinna defects. The non-hair bearing area in front of the ear provides tissue with excellent colour match, sturdy blood supply and sufficient length for transposition to the ear to reconstruct the helix in the upper part to the lobule in the lower part.