The Dieffenbach Flap for Reconstruction of Auricular Defects After Mohs Micrographic Surgery

Abstract

Auricle reconstruction is a challenging problem in plastic surgery due to the ear’s prominent location, complex anatomy, and limited local tissue availability. The Dieffenbach flap, a folded postauricular flap, offers a viable flap for reconstruction of larger ear defects. Although the technique has been well defined in previous literature, there are few studies evaluating its outcomes and complications. The authors conducted a retrospective review of patients who underwent auricle reconstruction with the Dieffenbach flap by a single surgeon between 2016 and 2022. Data collection included demographics, medical history, cancer type, defect characteristics, postoperative care, outcomes, and complications. Univariable analyses using the Fischer exact test assessed the association between risk factors (smoking, anticoagulation use, and age) and complication rates, with P ≤ 0.05 considered statistically significant. A total of 40 patients were included in this study, with a mean age of 67.6 and a male prevalence of 77.5%. The mean defect size was 6.5 cm2, with most defects located on the superior helix. The most common complication was postoperative cellulitis (3 patients, 7.5%), followed by contour abnormality that required revision surgery (2 patients, 5.0%). History of smoking had a statistically significant association with complications (P = 0.013). Use of anticoagulants, or older age (defined as >70 years), had no significant association with complication risk. The Dieffenbach flap remains a reliable method for reconstruction of various auricle defects. It is low maintenance, well tolerated by patients, and involves minimal donor site morbidity without the need for cartilage.