Reconstruction of the Auricle Defects

The pina is a common site of malignancies and traumatic injuries. The topographic shape of the pina, the convexities and concavities of the cartilage, and auricle s tenuous blood supply, present a surgical challenge in reconstructing partial pina defects. The reconstructed ear must match the opposite ear in orientation, size, and shape. Note must be made of any history of radiation therapy and the location of adjacent hair-bearing scalp. Several different techniques for partial auricular reconstruction have been described. The decision as to which technique is used depends on the size, the injured soft tissue components, and the location of the defect. Patient preferences and the surgeons comfort level with different techniques will also dictate the procedure chosen. Successful reconstruction of pina deformities requires appropriate restoration of the cartilaginous deformity as well as providing soft tissue support. A particular defect is further described by its anatomical location: helix, superior, middle, or inferior third of the auricle, and lobule. In the helical rim, full-thickness defects less than 1.5 cm are categorized as small, 1.5 to 2 cm as medium, and greater than 2 cm as large. When reconstructing a helical rim defect, one must have an accurate understanding of the deformity and approach the repair systematically. Vascular supply to the ear, tumor recurrence, cosmesis, and restoration of function (ie, support for hearing aids and eyeglasses) must be thoroughly discussed between the surgeon and the patient. Small defects (<1.5 cm) of the helix and antihelix can be repaired by conversion to wedge-shaped full-thickness excision with primary anastomosis. Medium defects (1.5 to 2 cm) can be repaired by composite grafts from the contralateral ear. Large defects can be repaired by using a temporoparietal fascial graft (TPFG) to cover autologous cartilage and serve as bedding for a second-stage skin graft.