Three-Stage Prelaminated Radial Forearm Flap for Total Auricular Reconstruction Following Scalp Avulsion Injury

Loss of mastoid skin and temporoparietal fascia after complete scalp avulsion precludes conventional ear reconstruction. We report a total auricular reconstruction using a remote, prelaminated radial-forearm flap. A 42-year-old woman with prior scalp avulsion and right ear amputation underwent (1) 200-mL forearm expansion, (2) autogenous costal-cartilage framework insertion and maturation, and (3) free transfer to the mastoid area anastomosed to the preserved proximal superficial temporal vessels. At 6 months the neo-auricle showed symmetric contour, color match, and defined helix/anti-helix; the donor forearm retained full wrist motion. No infection, minimal exposure, or cartilage resorption occurred. Remote, prelaminated radial-forearm flap auricular reconstruction provides a reliable benchmark for ear restoration when all local options have been exhausted.