Total ear reconstruction: The role of bilateral triangular post-auricular flaps for creation of the cephaloauricular sulcus

Abstract

Introduction: Auricular reconstruction of congenital or acquired ear defects can provide a realistic good-looking ear and functional cephaloauricular sulcus especially for those who wear eyeglasses. Over the past few years, refinements in the techniques of elevating the buried ear framework in the second stage of ear reconstruction have shifted from simple skin grafting to the use of flaps and cartilage blocks for creation of the cephaloauricular sulcus. 
Objective: The aim of the study was to describe useful simple modification using bilateral triangular flaps and full thickness skin graft to create adequately functional cephalo-auricular sulcus especially for patients wearing eyeglasses during the second stage ear reconstruction.
The study design: The described technique was carried out between June 2010 and January 2014, for 37 patients (24 patients with congenital microtia grade III, 7 patients with post-burn ear deformity, and 6 patients with post-traumatic ear defects). During the second stage of total ear reconstruction, the ear framework is separated substantially from the side of the head and positioned at the desired angle by means of a block of cartilage covered with a fascial flap. Then, two local triangular flaps from the adjacent non-hairy skin are created (one is superiorly based and the other is inferiorly based) and inset into the created cephaloauricular sulcus. The rest of the post-auricular defect is covered with a full thickness graft.
Results: The technique was simple and effective with no post-operative complication regarding flaps viability. Patients requiring glasses have worn frames soon after the tie-over was removed and no sulcus problems have resulted.