Reconstruction of Helical Defects: A Reproducible, Two-Stage Technique

Large full-thickness helical rim defects following skin cancer resection are a reconstructive challenge. We present a low-morbid, reproducible technique for medium to large helical rim defects and their outcomes.

A retrospective review of patients 18 years or older from 2014 to 2024 who underwent helical rim reconstruction using this technique following skin cancer resection was conducted. The technique begins with reducing the helical defect through wedge excision of the adjacent antihelix. Next, an ipsilateral conchal cartilage graft bridges the remaining defect. A local flap provides soft tissue coverage, and flap division occurs 3 to 4 weeks later.

A total of 22 patients, 5 females and 17 males (mean age 53.5) were identified. The average defect size was 3.79 cm by 2.90 cm. Flap coverage was achieved primarily by superiorly based postauricular flaps in 68.2% of cases. Complications included partial flap congestion in 2 patients (9.1%) and infection in 1 patient (4.5%). No flap failures or cartilage graft complications were observed. Three patients (13.6%) underwent in-office flap contour thinning.

The two-stage postauricular flap combined with wedge excision of the ipsilateral adjacent antihelix offers an effective, reproducible, low-morbid technique for auricular reconstruction.