Auricular reconstruction

1. Treat the underlying etiology: In cases of cancer, assure complete excision by using Mohs surgery. In cases of trauma, assure complete debridement of necrotic tissue and bring in healthy viable, well-vascularized tissue. 2. Assess the defect in detail: Analyze the defect in regard to composition (skin, cartilage, or both), effect of cartilaginous loss on overall structure, and need for cartilaginous replacement. 3. Skin only (FTSG or flap) is often enough: Wait 3 months after flap transposition before placing any subcutaneous graft material. 4. Treat the three "levels" as separate units. When advancing chondrocutaneous flaps in primary closure or rotating the entire ear in wedge resection closure, care should be taken to preserve the individual three level tiers (conchal bowl, scapha, helical rim/ lobule). 5. Use flap edema creatively. 6. Rarely consider total reconstruction in the adult.