The folded postauricular flap: A novel approach to reconstruction of large full thickness defects of the conchal bowl

Abstract

Extensive subtotal full-thickness auriculectomy defects pose a challenge for the reconstructive surgeon. The posterior island flap (PIF), based on the posterior auricular artery, has been described as a reconstructive option for auricular defects, with reports describing a "pull-through" or "revolving door" technique to reconstruct subtotal partial thickness and full thickness auricular defects. These techniques may result in posterior "pinning" of the auricle. This patient is an 87-year-old male who presented after Mohs excision of squamous cell carcinoma of the conchal bowl, which resulted in a 4x4cm subtotal auriculectomy defect. A folded PIF was used to reconstruct the large full thickness defect, in a multistage manor. Post-operatively, the patient had a reconstructed auricle that was suitable for wearing hearing aids and glasses. We describe a novel technique of the folded PIF for an extensive full-thickness auricular defect, which utilizes a single, well camouflaged donor site, provides well-vascularized local tissue with excellent color match, and allows for the restoration of the post-auricular sulcus.