Reconstruction of the ear in the absence of available retroauricular skin or ipsilateral temporoparietal fascia (TPF) flap integrity requires microvascular ear reconstruction. A 49-year-old patient’s missing left ear and scarring on both sides of the scalp were reconstructed with a prefabricated free flap. The patient used an osseointegrated ear prosthesis and requested an autologous reconstruction. The cartilage framework was constructed from rib cartilages and placed subcutaneously in the left distal forearm. Eight weeks later the prefabricated radial forearm flap with the ear framework (flap prelamination) was microvascularly transferred to the ear region. Two months later a revision surgery consisting of skin removal with soft-tissue sculpturing and grafting with split-thickness skin graft from the scalp was performed to improve shape, contour, and color match. The end result was an autologous structure with less-than-optimal definition and good color match. The overall results of microvascular ear reconstruction are inferior to classic reconstructions and should only be used in unfavorable anatomic situations.
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