SURGICAL
PEARL
A retroauricular flap for earlobe construction Schapoor Hessam, MD,a Dimitrios Georgas, MD,a Nina Bruns, MD,a Michael Sand, MD,a Tewfik Kassa, MD,b and Falk G. Bechara, MDa Bochum, Germany, and Mekelle, Ethiopia
SURGICAL CHALLENGE Reconstruction of the earlobe is a complicated task for dermatologic surgeons, and the aesthetic outcome is often limited.1
SOLUTION The outlines of the random pattern flap are marked on the retroauricular skin (Fig 1, A and B). The size of the defect and the dimension of the contralateral earlobe determine the length and width of the flap, with a length:width ratio not exceeding 3:1. The donor site offers hairless skin with a good match of color and skin texture. In most cases, there is enough tissue to reconstruct even large earlobes. The anteriorly based flap is raised, folded horizontally, and sutured to the surgical defect, with the end of the flap forming the posterior and its base the anterior part of the earlobe. The donor site is closed primarily (Fig 1, C ). As an alternative for closing the donor site, a skin graft or a flap raised from the neck is suitable. After 3 weeks, the flap is shaped to finally rebuild the new earlobe (Fig 2, A and B).
Fig 1. A, Marked outlines of the flap on the retroauricular skin. B, Excision defect of a lentigo maligna melanoma of the left earlobe and tragus. C, After raising the flap, it is folded horizontally and sutured to the surgical defect. The flap end formed the posterior layer of the earlobe and the flap base formed the anterior part. The retroauricular donor site is closed primarily.
From the Department of Dermatology, Venereology, and Allergology,a Ruhr-University Bochum, and the Department of Dermatology and Venereology,b Mekelle University, College of Health Sciences, Mekelle. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Falk G. Bechara, MD, Department of Dermatology, Venereology, and Allergology, Ruhr-University
Bochum, Gudrunstr 56, 44791 Bochum. E-mail: f.bechara@ klinikum-bochum.de. J Am Acad Dermatol 2014;71:e129-30. 0190-9622/$36.00 Ó 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.04.046
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Fig 2. A, Result 3 weeks after the first-stage procedure. B, In a second-stage procedure 3 weeks later, the flap is shaped and sutured to rebuild the new earlobe using the contralateral earlobe as a model. C, Result 4 months after the second-stage procedure.
Our presented technique is particularly suitable for wide and horizontal earlobe defects. For vertically extending defects with helix involvement, the presented flap can be modified to a vertically folded pedicled flap. The described technique is simple to perform in local anesthesia in an outpatient setting. It allows for reconstruction of the earlobe with good aesthetic and functional results (Fig 2, C ). In addition, scars are well hidden behind the ear, and shaping the flap in a second-stage procedure reduces the risk of impaired flap circulation. REFERENCE 1. Clevens RA, Baker SR. Plastic and reconstructive surgery of the earlobe. Facial Plast Surg 1995;11:301-9.