Repair of a Large Ear Defect Including the Triangular Fossa

Large ear defects in dermatologic surgery can present a difficult challenge to achieve excellent functional and cosmetic results. This article describes a difficult case of a large ear defect as well as considerations for resolution. A 67-year-old male presented for Mohs micrographic surgery of a basal carcinoma of the left ear. Prior skin biopsy showed a nodular and sclerosing basal cell carcinoma that extended to biopsy margins. The lesion was excised in 3 Mohs stages with negative margins in the last stage. Final defect size was 3.5×2.3 cm and extended across the scapha and the crura of the antihelix. Various closure modalities were considered and discussed. Due to extensive tissue loss and size/depth of defect, a preauricular interpolation flap was utilized to best preserve normal anatomic and functional relationships. The patient had an excellent postoperative outcome, including long-term follow-up at 6 months. This case presents a surgical conundrum of a large ear defect and considerations for closure in such cases, as well as a resolution.