The authors have indicated no significant interest with commercial supporters.S urgical defects of the auricular helix generally require reconstruction to maintain the contiguous border of the helical rim. Whereas the traditional helical advancement flap ( Figure 1A) provides an excellent repair for defects along the lateral helix, this flap is not ideally suited for repair of defects of the superior helix. We report a superior helical advancement flap that utilizes donor skin from the laxity of the superior preauricular area to repair defects of the superior helical rim ( Figure 1B).
MethodsSeven patients with Mohs micrographic surgery defects of the superior helix repaired in this fashion by one surgeon (AKA) were included in the study. The flaps were devised by incising along the inferior margin of the helical rim toward the superior border of the tragus (Figure 2). Backcuts were made into the superior portion of the preauricular crease to free the lax preauricular skin and allow advancement of the flap. Dog-ears were removed in the posterior ear. The flaps were undermined superiorly in a subcutaneous plane as well as on the posterior ear above the perichondrium. The flaps were then advanced to cover the surgical defects. Suturing was performed using 5-0 nylon sutures. No subcuticular sutures were used in this flap except when needed to repair the preauricular crease. Sutures were removed 1 week postoperatively.
ResultsThe defects measured 2.5 Â 1.0, 2.4 Â 0.9, 2.0 Â 1.5, 2.0 Â 1.2, 1.7 Â 0.9, 1.5 Â 1.0, and 1.3 Â 1.0 cm (mean, 1.9 Â 1.1 cm). Each defect was successfully repaired with this flap with no notable distortion of the ear. Helical rims were maintained in a smooth, contiguous fashion. There was no flap necrosis or trapdooring noted. There was no significant postoperative pain, chondritis, infection, or dehiscence. Postoperative surgical revisions were not required.