Anterior Ear Reconstruction with the Posterior Pull-through Flap

Area of Science:

• Plastic Surgery
• Otolaryngology
• Dermatologic Surgery

Background:

• Central ear defects following skin cancer excision pose a reconstructive challenge.
• The postauricular skin-island flap offers a potential solution for these defects.

Purpose of the Study:

• To evaluate the efficacy and safety of a one-stage, postauricular skin-island flap for reconstructing anterior ear defects.
• To assess the flap's ability to maintain ear shape and position.

Main Methods:

• Reconstruction of anterior full-thickness ear defects using a skin-island flap based on posterior subcutaneous tissue.
• The flap was passed through a created aperture in the ear cartilage to avoid epithelial burial.
• Suturing of flap periphery and harvest site with absorbable sutures.

Main Results:

• Successful single-stage reconstruction in 22 patients over 9 years for defects ranging from 2-4.5 cm.
• The technique provided structural support and prevented ear distortion; no flap necrosis occurred.
• Common venous congestion was self-limiting, with no epithelial cysts observed.

Conclusions:

• The one-stage postauricular skin-island flap reliably reconstructs anterior ear defects without compromising ear aesthetics.
• Creating a generous cartilage aperture is crucial for flap passage.
• This posteriorly-based, pass-through flap offers predictable healing with minimal complications.