Surgery of the auricle

Auricular reconstruction is a unique area of facial plastic surgery where a wide array of reconstructive options often must be considered. The external ear is unique in its aesthetic role where the normal auricle often goes unnoticed; yet even a small irregularity can stand out and become conspicuous. The reconstruction of large or total auricular defects is a combination of science and art. Two forms of auricular reconstruction are discussed: (1) those for a congenitally abnormal shape but no acquired tissue deficiency, that is, otoplasty, and (2) repairs requiring a reconstruction of discrete loss of tissue. A general algorithm is presented that can assist with flap selection and covers the techniques for grafts, framework repair, local and pedicled flaps, temporoparietal facial flaps, and auricular prostheses.