The trap door flap: A reliable, reproducible method of anterior pinna reconstruction

Abstract

Resection of skin cancers of the conchal fossa and anti-helical rim presents a challenging reconstructive problem. A full thickness skin graft is often used following excision of the cartilage underlying the lesion. Colour mismatch, a contour defect and a donor site scar are potential drawbacks to this method of reconstruction. The postauricular trap door flap offers a superior option for these defects. This study aims to assess the reliability and outcomes of the trap door flap for defects of the anterior surface of the pinna. A retrospective review of all trap door flaps carried out in Galway University Hospital was carried out. Charts were reviewed in order to examine operative notes and assess for any complications and length of follow up. 45 Patients were operated on by a single surgeon. The age range was 61-93 years. The majority of lesions excised were from the conchal area with 6 defects predominantly involving the scapha. No partial or complete flap loss occurred. 2 patients required further excision due to an incomplete margin and a local recurrence respectively. Follow up ranged from 3 months to 4 years with excellent cosmetic results were achieved in all cases with no scar issues at the flap or donor sites. The trap door flap is an excellent method of conchal reconstruction. It is reliable and reproducible with no flap loss demonstrated in our series of 45 patients. Large defects can be reconstructed with this flap and the cosmetic result in terms of colour and contour, as well as a hidden donor site scar, make this a superior option to a full thickness skin graft.