J‐Shaped, Conchal Excision With Rotation Advancement for Closure of Large, Auricular Wedge Defects

Abstract

INTRODUCTIONLesions of the auricle constitute about 12% of all cutaneous basal and squamous cell carcinomas in the head and neck area.1 Because of the visibility of this area, aesthetic reconstruction is a concern after complete extirpation of the primary tumor. The authors present a J-shaped, conchal excision which allows superior rotation of the remaining pinna and simplified closure of moderately large, full-thickness defects of the auricle with minimal cupping of the helical rim. As the lower pinna is rotated into the defect, loss of vertical dimension is limited to the inferior portion of the auricle, which leaves the superior rim of the helix at its preoperative level. TECHNIQUENeoplasms which affect the auricle margin were completely excised with a full-thickness wedge resection (Figs. 1,2), and negative margins were verified by examining frozen sections. The J-shaped, conchal excision was used when the remaining wedge defect was between 2 and 2.5 cm. Simple closure of such a large defect would have caused considerable cupping of the pinna. The J-shaped excision was drawn into the concha and excised to include skin and cartilage. Undermining was done about 3 mm beyond the edges of the conchal excision. The inferior portion of ear was rotated superiorly into place and held with one or two buried sutures of #4-0 clear nylon. These sutures were placed through cartilage and perichondrium along the potential stress points. The free edges of the wedge resection were trimmed to allow realignment of the au-From the Department of Head and Neck Surgery -5693. ricular margin, and care was taken to align the concha, antihelix, and helical rim. The subcutaneous tissues were reapproximated with a #4-0 absorbable suture, and interrupted, #5-0 monofilament sutures were used to reapproximate the skin edges (Fig. 3). Vertical mattress sutures along the helical rim reduced postoperative notching. A cup-shaped, external dressing was applied for the first 2 to 3 postoperative days, and sutures were removed after 7 days. The postoperative results were good, and the height of the helical rim was maintained (Fig. 4, left).

Single staged, z-plasty supported, wedge excision modification for treatment of auricular lesions under local anesthesia: a technical note

“…7 Methods for reconstruction of auricular rim defects can be divided into techniques for closure of partial-thickness defects (skin or pericondrium, or both) or techniques for closure of full-thickness defects (skin and cartilage). 4,7 Options for closure of full-thickness defects include; simple primary closure, contralateral conchal cartilage composite grafts, preauricular flaps 12 , staged postauricular flaps 10 , various subperichondrial wedge resections of the cartilage 17 , thin tubed mastoid flaps 16 , Banner flaps 6 , Converse's tunnel procedure 5 , advancement of condrocutaneous flaps of adjacent rim tissues 1,2,8,13 , rotation or advancement chondrocutaneous flaps 7 and rotation-advancement of the earlobe tissue 18 for smaller, inferior defects.…”