Auricular reconstruction with the use of a modified rhomboid flap

Abstract

Sir, We describe a simple, safe one-stage procedure for reconstruction of marginal helical defects. Auricular reconstruction after trauma, burn or local excision of tumours has been a common challenge in plastic surgery. Apart from functional importance, the ear also has great aesthetic value, because it frames the face and provides symmetry. A common defect on the ear is partial loss of the helical margin with or without a cartilage defect. Keeping general principles in mind, one can consider various surgical options, based on a reconstructive triangle approach. One effective solution is the use of the rhomboid flap [1]. The skin defect over the superior part of the ear can be covered by a superiorly based random pattern post-auricular flap designed on the non-hair bearing area, this has the advantage of having the same skin colour as the original auricular skin (Figs. 1, 2, 3 and 4). Although the dimensions and shape of both defect and flap are precise, they are variables in planning, namely which of four potential flaps should be used, and the axis around which the excisional rhomboid is be drawn. It is possible to manipulate these variables in such a way that closure of the secondary defect makes use of the laxity of the skin present (use of Dufourmental instead of Limberg flap). A further advantage of this flap is that the donor site scarring comes to lie behind the ear and is, therefore, inconspicuous. The anterior edge of the flap can be cut along the retroauricular sulcus. The greater skin mobility on the post-auricular surface, coupled with the fact that ear tolerates being set back closer to the head, increases the role of this flap considerably. There is some loss of the curve of the helical margin, but patients tend to be in an older age group and thus the result can be acceptable. For small defects, a simple transposition flap that is designed as a formal rhomboid flap is a useful option (Figs. 5, 6). In this situation, Fortier-Riberdy et al. gave some useful tips [2]: