The authors have indicated no significant interest with commercial supporters.T he removal of skin cancers on the ear may leave the surgeon with a reconstructive challenge, especially when there is full-thickness loss of cartilage. Historically, this would have necessitated a two-stage pedicle procedure or involved multiple surgical sites on the face to achieve an aesthetically pleasing appearance. To preserve normal auricular contours, various reconstruction options have been previously described, 1-7 including interpolation flaps and free cartilage grafts harvested from the contralateral or ipsilateral ear. Although these procedures can reliably restore ear contour and integrity, they require several stages and do so at a cost of additional wounds. Wedge resection of the ear will decrease the vertical height of the ear and has the potential to create a cupped appearance. 2 The use of a cartilage hinge flap is a novel reconstruction option, allowing the physician to perform a one-stage procedure using only one facial operative site. The hinge concept allows for some viable perichondrium to be maintained, fills in the defect, maintains the natural rim contour, and precludes the need to harvest cartilage from another area.
Case Report and TechniqueThe patient was a 75-year-old man with a recurrent squamous cell carcinoma on the mid-antihelix of the left ear (Figure 1). A tumor-free plane was achieved after two Mohs stages, leaving a 2.8-by 2.0-cm defect (Figure 2). Full-thickness cartilage was removed from the majority of the defect, leaving only postauricular skin and a thin margin of cartilage along the helical rim. To prevent possible collapse of the helical rim, cartilage support was necessary. We devised a single-stage cartilage hinge flap to support the structure of the ear, along with a superimposed full-thickness skin graft.The following reconstructive procedure was performed. An incision was made inferior to the defect, and the cartilage of the inferior antihelix was exposed. A 0.4-by 2.8-cm strip of cartilage was incised and elevated, maintaining a vascular pedicle at the superior margin (Figure 3). The flap was then elevated and rotated 1801 and sutured to the upper edge of the surgical defect with 5-0 Monocryl absorbable suture (Figure 4). The donor site for the hinge flap was repaired in a layered fashion using 5-0 Monocryl to approximate the cartilage and 5-0 nylon suture to close the overlying skin ( Figure 5). The original defect and cartilage hinge flap was covered with a full-thickness skin graft obtained from the left clavicle. The graft was sutured into place with 5-0 fast-absorbing gut. Finally, the graft was secured with a tie-over bolster dressing. One week later, the bolster and sutures were removed, and the graft was viable. The dusky appearance of the medial portion of the graft can be attributed to the reduced vascularity of the cartilage in that portion of the recipient bed. Minimal epidermal sloughing occurred over this portion of the graft
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