Extended earlobe transposition flap

Introduction: The ear and earlobe are frequently exposed to trauma and skin tumors. There are few options available for treating central defects of the auricular concha, antitragus, external auditory meatus, and external auditory canal. Healing by secondary intention and layered skin grafting are among the reconstruction options. Flaps from the retroauricular mastoid region are the most commonly used and perhaps the only flaps that can best reach this area.
The objective of this work is to present the application of a novel flap derived from the earlobe for the reconstruction of the central region of the middle 1/3 of the ear (from the external auditory canal, external acoustic meatus, antitragus, auricular concha to the antihelix).
Method: Prospective descriptive work based on a series of cases of central defects of the middle 1/3 of the ear using the extended earlobe transposition flap. Results: There have been 5 cases operated on so far, all for the treatment of basal cell carcinoma. The flap survived in all cases with immediate resolution of the defects created after tumor resection.
Discussion: There are few options for flap reconstruction of the central region of the ear. A local flap from the middle 1/3 or upper 1/3 of the ear does not exist, and a local flap from the lower 1/3 (earlobe) has not yet been described for this purpose.
The only earlobe flaps described are for posterior rotation for defects on the lateral side of the middle ear third or for anterior rotation for antitragus reconstruction.
Flaps from the retroauricular mastoid region require two surgical stages and create scars in the donor area while not reaching the external auditory meatus and external auditory canal.
The extended earlobe flap proved effective in covering extensive defects and even reaching deep into the external auditory canal. It showed itself to be quite versatile with both anterior pedicle (cases 1, 2, 3, and 4) and posterior pedicle (case 5). Another advantage is minimal morbidity in the donor area, following the principles of aesthetic surgery for earlobe "rejuvenation."
Conclusion: This work describes a new local flap for reconstructing the anterior central region of the ear and auditory canal. The extended earlobe flap proved to be safe, versatile, and reproducible in resolving the cases presented.

Reconstructive

PSTM 2024