A preauricular banner transposition flap was used to repair the medial one-third of the conchal defect. A small area was left to heal by secondary intention (Figure 3).
FIGURE 3. In stage 1 of the repair, the retroauricular flap was pulled through the incision in posterior auricular skin and sutured to the anterior auricular surface. This “sandwich” comprised the following tissue layers (ordered anterior to posterior): retroauricular interpolation flap, cartilage graft, and intact posterior auricular skin.
Stage 2—The patient returned 3 weeks later for division and inset of the retroauricular interpolation flap. The pedicle of the flap was severed and its free edge was sutured into the lateral aspect of the defect. The posterior auricular incision that the flap had been pulled through in stage 1 of the repair was closed in a layered fashion, and the secondary defect of the postauricular scalp was left to heal by secondary intention (Figure 4).
FIGURE 4. In stage 2 of the repair, the retroauricular flap pedicle was incised and inset into the lateral aspect of the defect.
Final Results—At follow-up 1 month later, the patient was noted to have good aesthetic and functional outcomes (Figure 5).
FIGURE 5. At 1 month following the takedown of the retroauricular pull-through sandwich flap, the surgical site was fully healed with a good aesthetic and functional outcome.
Practice Implications
The retroauricular pull-through sandwich flap combines a cartilage graft and a retroauricular interpolation flap pulled through an incision in the posterior auricular skin to resurface the anterior ear. This repair is most useful for a large conchal bowl defect in which there is extensive missing cartilage but intact posterior auricular skin.
The retroauricular scalp is a substantial tissue reservoir with robust vasculature; an interpolation flap from this area frequently is used to repair an extensive ear defect. The most common use of an interpolation flap is for a large helical defect; however, the flap also can be pulled through an incision in the posterior auricular skin to the front of the ear in a manner similar to revolving-door and flip-flop flaps, thus allowing for increased flap reach.
A cartilage graft provides structural support, helping to maintain auricular projection. The helical arcades provide a robust vascular supply and maintain viability of the helical rim tissue, despite the large aperture created for the pull-through flap.
We recommend this 2-stage repair for large conchal bowl defects with extensive cartilage loss and intact posterior auricular skin.