Repairs of the Ear

  • Sean R. ChristensenEmail author
  • Christopher R. Stamey


The external ear, or auricle, is a complex three-dimensional structure with an intricate topography that presents unique reconstructive challenges. Consideration of the anatomic, functional, and cosmetic requirements of the auricle facilitates effective surgical reconstruction. Repairs of the ear can be divided into four major categories that address these requirements in different ways: linear and wedge repairs, skin grafts, single-staged flaps, and multi-staged flaps. There is strong evidence to support the efficacy and safety of auricular reconstruction, and specific categories of repair are optimally suited to particular types of defects. However, with few exceptions, there is a paucity of high-level evidence that directly compares the outcomes of one repair type to another. This chapter provides an evidence-based review of each of the major categories of auricular reconstruction. As an alternative to reconstruction, healing by second intention can be a viable option for surgical defects of the ear, and long-term functional and cosmetic outcomes may be comparable to primary repair for appropriately selected defects.


Surgical reconstruction Linear repair Wedge repair Local cutaneous flap Chondrocutaneous flap Interpolation flap Skin graft Second intention healing 


  1. 1.
    Mevorah B, Bovet R. Treatment of retroauricular keratinous cysts. J Dermatol Surg Oncol. 1984;10:40–4.CrossRefGoogle Scholar
  2. 2.
    Al Aradi IK, Alawadhi SA, Alkhawaja FA, Alaradi I. Earlobe keloids: a pilot study of the efficacy of keloidectomy with core fillet flap and adjuvant intralesional corticosteroids. Dermatol Surg. 2013;39:1514–9.PubMedGoogle Scholar
  3. 3.
    Brown NA, Ortega FR. The role of full-thickness skin grafting and steroid injection in the treatment of auricular keloids. Ann Plast Surg. 2010;64:637–8.PubMedGoogle Scholar
  4. 4.
    Burm JS, Hansen JE. Full-thickness skin grafting with marginal deepithelialization of the defect for reconstruction of helical rim keloids. Ann Plast Surg. 2010;65:193–6.CrossRefGoogle Scholar
  5. 5.
    Kim DY, Kim ES, Eo SR, Kim KS, Lee SY, Cho BH. A surgical approach for earlobe keloid: keloid fillet flap. Plast Reconstr Surg. 2004;113:1668–74.CrossRefGoogle Scholar
  6. 6.
    Louis PJ, Aponte-Wesson RA, Fernandes RP, Clemow J. Autogenous and prosthetic reconstruction of the ear. Oral Maxillofac Surg Clin North Am. 2013;25:271–86.CrossRefGoogle Scholar
  7. 7.
    Nagata S. A new method of total reconstruction of the auricle for microtia. Plast Reconstr Surg. 1993;92:187–201.CrossRefGoogle Scholar
  8. 8.
    Kuijpers DI, Smeets NW, Lapiere K, Thissen MR, Krekels GA, Neumann HA. Do systemic antibiotics increase the survival of a full thickness graft on the nose? J Eur Acad Dermatol Venereol. 2006;20:1296–301.CrossRefGoogle Scholar
  9. 9.
    Goltsman D, Munabi NC, Ascherman JA. The association between smoking and plastic surgery outcomes in 40,465 patients: an analysis of the American College of Surgeons National Surgical Quality Improvement Program Data Sets. Plast Reconstr Surg. 2017;139:503–11.CrossRefGoogle Scholar
  10. 10.
    Pluvy I, Panouilleres M, Garrido I, et al. Smoking and plastic surgery, part II. Clinical implications: a systematic review with meta-analysis. Ann Chir Plast Esthet. 2015;60:e15–49.CrossRefGoogle Scholar
  11. 11.
    Hochwalt PC, Christensen KN, Cantwell SR, et al. Comparison of full-thickness skin grafts versus second-intention healing for Mohs defects of the helix. Dermatol Surg. 2015;41:69–77.CrossRefGoogle Scholar
  12. 12.
    Leibovitch I, Huilgol SC, Richards S, Paver R, Selva D. The Australian Mohs database: short-term recipient-site complications in full-thickness skin grafts. Dermatol Surg. 2006;32:1364–8.PubMedGoogle Scholar
  13. 13.
    Levin BC, Adams LA, Becker GD. Healing by secondary intention of auricular defects after Mohs surgery. Arch Otolaryngol Head Neck Surg. 1996;122:59–66. discussion 67.CrossRefGoogle Scholar
  14. 14.
    Nishimura RA, Otto CM, Bonow RO, et al. AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 2014. 2014;63:e57–185.CrossRefGoogle Scholar
  15. 15.
    Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;116:1736–54.CrossRefGoogle Scholar
  16. 16.
    Wright TI, Baddour LM, Berbari EF, et al. Antibiotic prophylaxis in dermatologic surgery: advisory statement 2008. J Am Acad Dermatol. 2008;59:464–73.CrossRefGoogle Scholar
  17. 17.
    Larcher L, Plotzeneder I, Tasch C, Riml S, Kompatscher P. Retroauricular pull-through island flap for defect closure of auricular scapha defects--a safe one-stage technique. J Plast Reconstr Aesthet Surg. 2011;64:934–6.CrossRefGoogle Scholar
  18. 18.
    Cordova A, Pirrello R, D’Arpa S, Moschella F. Superior pedicle retroauricular island flap for ear and temporal region reconstruction: anatomic investigation and 52 cases series. Ann Plast Surg. 2008;60:652–7.CrossRefGoogle Scholar
  19. 19.
    Dessy LA, Figus A, Fioramonti P, Mazzocchi M, Scuderi N. Reconstruction of anterior auricular conchal defect after malignancy excision: revolving-door flap versus full-thickness skin graft. J Plast Reconstr Aesthet Surg. 2010;63:746–52.CrossRefGoogle Scholar
  20. 20.
    Elsahy NI. Ear reconstruction with a flap from the medial surface of the auricle. Ann Plast Surg. 1985;14:169–79.CrossRefGoogle Scholar
  21. 21.
    Fader DJ, Johnson TM. Ear reconstruction utilizing the subcutaneous island pedicle graft (flip-flop) flap. Dermatol Surg. 1999;25:94–6.CrossRefGoogle Scholar
  22. 22.
    Humphreys TR, Goldberg LH, Wiemer DR. The postauricular (revolving door) island pedicle flap revisited. Dermatol Surg. 1996;22:148–50.PubMedGoogle Scholar
  23. 23.
    Krespi YP, Pate BR Jr. Auricular reconstruction using postauricular myocutaneous flap. Laryngoscope. 1994;104:778–80.CrossRefGoogle Scholar
  24. 24.
    Papadopoulos ON, Karypidis DK, Chrisostomidis CI, Konofaos PP, Frangoulis MB. One-stage reconstruction of the antihelix and concha using postauricular island flap. Clin Exp Dermatol. 2008;33:647–50.CrossRefGoogle Scholar
  25. 25.
    Renard A. Postauricular flap based on a dermal pedicle for ear reconstruction. Plast Reconstr Surg. 1981;68:159–65.CrossRefGoogle Scholar
  26. 26.
    Schonauer F, Vuppalapati G, Marlino S, Santorelli A, Canta L, Molea G. Versatility of the posterior auricular flap in partial ear reconstruction. Plast Reconstr Surg. 2010;126:1213–21.CrossRefGoogle Scholar
  27. 27.
    Talmi YP, Horowitz Z, Bedrin L, Kronenberg J. Auricular reconstruction with a postauricular myocutaneous island flap: flip-flop flap. Plast Reconstr Surg. 1996;98:1191–9.CrossRefGoogle Scholar
  28. 28.
    Turan A, Turkaslan T, Kul Z, Isler C, Ozsoy Z. Reconstruction of the anterior surface of the ear using a postauricular pull-through neurovascular island flap. Ann Plast Surg. 2006;56:609–13.CrossRefGoogle Scholar
  29. 29.
    Kirkorian AY, Moore BL, Siskind J, Marmur ES. Perioperative management of anticoagulant therapy during cutaneous surgery: 2005 survey of Mohs surgeons. Dermatol Surg. 2007;33:1189–97.PubMedGoogle Scholar
  30. 30.
    Ibrahim AM, Rabie AN, Borud L, Tobias AM, Lee BT, Lin SJ. Common patterns of reconstruction for Mohs defects in the head and neck. J Craniofac Surg. 2014;25:87–92.CrossRefGoogle Scholar
  31. 31.
    Reddy LV, Zide MF. Reconstruction of skin cancer defects of the auricle. J Oral Maxillofac Surg. 2004;62:1457–71.CrossRefGoogle Scholar
  32. 32.
    Radonich MA, Zaher M, Bisaccia E, Scarborough D. Auricular reconstruction of helical rim defects: wedge resection revisited. Dermatol Surg. 2002;28:62–5.PubMedGoogle Scholar
  33. 33.
    Kitchens GG. Auricular wedge resection and reconstruction. Ear Nose Throat J. 1989;68:673–674, 677–679, 683.Google Scholar
  34. 34.
    Taylor JM, Rajan R, Dickson JK, Mahajan AL. Maintaining ear aesthetics in helical rim reconstruction. Ann Plast Surg. 2014;72:318–22.CrossRefGoogle Scholar
  35. 35.
    Trufant JW, Marzolf S, Leach BC, Cook J. The utility of full-thickness skin grafts (FTSGs) for auricular reconstruction. J Am Acad Dermatol. 2016;75:169–76.CrossRefGoogle Scholar
  36. 36.
    Petersen JF, Borggreven PA, Koot VC, Tegelberg MJ, Lohuis PJ. Paradigm change in the treatment of non-melanoma skin cancer of the auricle: reconstruction with full thickness skin grafting instead of wedge excision. Eur Arch Otorhinolaryngol. 2015;272:1743–8.CrossRefGoogle Scholar
  37. 37.
    Shimizu I, MacFarlane DF. Full-thickness skin grafts may not need tie-over bolster dressings. Dermatol Surg. 2013;39:726–8.CrossRefGoogle Scholar
  38. 38.
    Lear W, Odland P. Combination full- and split-thickness skin grafts for superficial auricular wounds. Dermatol Surg. 2010;36:1453–6.CrossRefGoogle Scholar
  39. 39.
    McCary WS, Kryzer TC, Lambert PR. Application of split-thickness skin grafts for acquired diseases of the external auditory canal. Am J Otol. 1995;16:801–5.PubMedGoogle Scholar
  40. 40.
    Wines N, Ryman W, Matulich J, Wines M. Retrospective review of reconstructive methods of Conchal bowl defects following mohs micrographic surgery. Dermatol Surg. 2001;27:471–4.PubMedGoogle Scholar
  41. 41.
    Sage RJ, Leach BC, Cook J. Antihelical cartilage grafts for reconstruction of mohs micrographic surgery defects. Dermatol Surg. 2012;38:1930–7.CrossRefGoogle Scholar
  42. 42.
    Kontis TC, Papel ID. Reconstruction of congenital and acquired auricular scaphal deficiencies. Arch Facial Plast Surg. 2003;5:263–6.CrossRefGoogle Scholar
  43. 43.
    Eser C, Kerem M, Olguner AA, Gencel E, Kesiktas E. A new technique for the surgical repair of double cleft earlobe: modified Millard’s rotation-advancement flap. Int J Oral Maxillofac Surg. 2015;44:374–6.CrossRefGoogle Scholar
  44. 44.
    Goldberg LH, Mauldin DV, Humphreys TR. The postauricular cutaneous advancement flap for repairing ear rim defects. Dermatol Surg. 1996;22:28–31.PubMedGoogle Scholar
  45. 45.
    Kang S, Moon SJ, Suh H. Traumatic cleft earlobe repair: using a double triangular flap for differently sized components on either side of the cleft. Aesthet Plast Surg. 2013;37:1163–6.CrossRefGoogle Scholar
  46. 46.
    Singh A, Singh G. Earlobe reconstruction using a Limberg flap in six ears. Br J Plast Surg. 2003;56:33–6.CrossRefGoogle Scholar
  47. 47.
    Suh H. Traumatic cleft earlobe repair using double triangular flap from epithelialized skin of cleft margin. J Craniofac Surg. 2014;25:976–7.CrossRefGoogle Scholar
  48. 48.
    Kimyai-Asadi A, Goldberg LH, Vujevich J, Jih MH. Superior helical rim advancement flap for the repair of ear defects. Dermatol Surg. 2008;34:558–60.PubMedGoogle Scholar
  49. 49.
    Alam M, Goldberg LH. Two-lobed advancement flap for cutaneous helical rim defects. Dermatol Surg. 2003;29:1044–9.PubMedGoogle Scholar
  50. 50.
    Antia NH, Buch VI. Chondrocutaneous advancement flap for the marginal defect of the ear. Plast Reconstr Surg. 1967;39:472–7.CrossRefGoogle Scholar
  51. 51.
    El-Sabbagh AH. Davis flap: the glory still present. GMS Interdiscip Plast Reconstr Surg DGPW 2016;5: 20160504.Google Scholar
  52. 52.
    Medeiros J, Belerique M, Antunes E, Franco D, Franco T. Chondrocutaneous marginal ear flap. J Craniofac Surg. 2009;20:862–3.CrossRefGoogle Scholar
  53. 53.
    Noel W, Leyder P, Quilichini J. Modified Antia-Buch flap for the reconstruction of helical rim defects. J Plast Reconstr Aesthet Surg. 2014;67:1659–62.CrossRefGoogle Scholar
  54. 54.
    Ramirez OM, Heckler FR. Reconstruction of nonmarginal defects of the ear with chondrocutaneous advancement flaps. Plast Reconstr Surg. 1989;84:32–40.CrossRefGoogle Scholar
  55. 55.
    Valesky EM, Kaufmann R, Meissner M. Chondrocutaneous helix rim advancement flap: two classical and two new modifications for very large defects of the ear. J Eur Acad Dermatol Venereol. 2015;29:2248–51.CrossRefGoogle Scholar
  56. 56.
    Zilinsky I, Cotofana S, Hammer N, et al. The arterial blood supply of the helical rim and the earlobe-based advancement flap (ELBAF): a new strategy for reconstructions of helical rim defects. J Plast Reconstr Aesthet Surg. 2015;68:56–62.CrossRefGoogle Scholar
  57. 57.
    Krespi YP, Ries WR, Shugar JM, Sisson GA. Auricular reconstruction with postauricular myocutaneous flap. Otolaryngol Head Neck Surg. 1983;91:193–6.CrossRefGoogle Scholar
  58. 58.
    Cordova A, D’Arpa S, Pirrello R, Giambona C, Moschella F. Retroauricular skin: a flaps bank for ear reconstruction. J Plast Reconstr Aesthet Surg. 2008;61(Suppl 1):S44–51.CrossRefGoogle Scholar
  59. 59.
    McInerney NM, Piggott RP, Regan PJ. The trap door flap: a reliable, reproducible method of anterior pinna reconstruction. J Plast Reconstr Aesthet Surg. 2013;66:1360–4.CrossRefGoogle Scholar
  60. 60.
    Deng CL, Yang SL, Zheng JH, Mao GY, Wan WD. Reconstruction of the partial pinna using autologous ear cartilage combined with a local sliding skin flap. J Plast Reconstr Aesthet Surg. 2014;67:869–71.CrossRefGoogle Scholar
  61. 61.
    Farber N, Haik J, Weissman O, Israeli H, Winkler E, Zilinsky I. Delay techniques for local flaps in dermatologic surgery. J Drugs Dermatol. 2012;11:1108–10.PubMedGoogle Scholar
  62. 62.
    Johnson TM, Fader DJ. The staged retroauricular to auricular direct pedicle (interpolation) flap for helical ear reconstruction. J Am Acad Dermatol. 1997;37:975–8.CrossRefGoogle Scholar
  63. 63.
    Ottat MR. Partial reconstruction of the external ear after a trauma: simple and efficient techniques. Braz J Otorhinolaryngol. 2010;76:7–13.CrossRefGoogle Scholar
  64. 64.
    Chambers JA, Davis MR, Rasmussen TE. A band of surgeons, a long healing line: development of craniofacial surgery in response to armed conflict. J Craniofac Surg. 2010;21:991–7.CrossRefGoogle Scholar
  65. 65.
    Freshwater MF. A critical comparison of Davis’ principles of plastic surgery with Gillies’ plastic surgery of the face. J Plast Reconstr Aesthet Surg. 2011;64:17–26.CrossRefGoogle Scholar
  66. 66.
    Di Mascio D, Castagnetti F. Tubed flap interpolation in reconstruction of helical and ear lobe defects. Dermatol Surg. 2004;30:572–8.PubMedGoogle Scholar
  67. 67.
    Ellabban MG, Maamoun MI, Elsharkawi M. The bi-pedicle post-auricular tube flap for reconstruction of partial ear defects. Br J Plast Surg. 2003;56:593–8.CrossRefGoogle Scholar
  68. 68.
    Iljin A, Lewandowicz E, Antoszewski B, Zielinski T. Results of auricular helical rim reconstruction with post-auricular tube flap. Pol Przegl Chir. 2016;88:32–7.PubMedGoogle Scholar
  69. 69.
    Park L, Bordeaux JS. Staged island pedicle flap and tube flap to repair a full-thickness defect of the upper third of the ear. Dermatol Surg. 2013;39:1922–6.CrossRefGoogle Scholar
  70. 70.
    Suchin KR, Greenbaum SS. Preauricular tubed pedicle flap repair of a superior antihelical defect. Dermatol Surg. 2004;30:239–41.PubMedGoogle Scholar
  71. 71.
    Brent B, Byrd HS. Secondary ear reconstruction with cartilage grafts covered by axial, random, and free flaps of temporoparietal fascia. Plast Reconstr Surg. 1983;72:141–52.CrossRefGoogle Scholar
  72. 72.
    Cheney ML, Varvares MA, Nadol JB Jr. The temporoparietal fascial flap in head and neck reconstruction. Arch Otolaryngol Head Neck Surg. 1993;119:618–23.CrossRefGoogle Scholar
  73. 73.
    Demirdover C, Sahin B, Vayvada H, Oztan HY. The versatile use of temporoparietal fascial flap. Int J Med Sci. 2011;8:362–8.CrossRefGoogle Scholar
  74. 74.
    Olson KL, Manolidis S. The pedicled superficial temporalis fascial flap: a new method for reconstruction in otologic surgery. Otolaryngol Head Neck Surg. 2002;126:538–47.CrossRefGoogle Scholar
  75. 75.
    Rose EH, Norris MS. The versatile temporoparietal fascial flap: adaptability to a variety of composite defects. Plast Reconstr Surg. 1990;85:224–32.CrossRefGoogle Scholar
  76. 76.
    Ozturk S, Sengezer M, Zor F. Reconstruction of acquired partial auricular defects by porous polyethylene implant and superficial temporoparietal fascia flap in adult patients. Plast Reconstr Surg. 2006;118:1349–57.CrossRefGoogle Scholar
  77. 77.
    Mavropoulos JC, Bordeaux JS. The temporoparietal fascia flap: a versatile tool for the dermatologic surgeon. Dermatol Surg. 2014;40(Suppl 9):S113–9.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Dermatology, Section of Dermatologic SurgeryYale University School of MedicineNew HavenUSA
  2. 2.Department of DermatologyYale University School of MedicineNew HavenUSA

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