The auricle is split into six specific anatomic subunits that vary in skin thickness, contour, structural integrity and the availability of healthy surrounding tissues. It is important to reconstruct an aesthetically pleasing auricle as slight deformities may be prominent. The authors describe the latest suggested types of grafts and techniques to choose for ideal restoration of postoperative resections of auricles based on defect size and its anatomical zone. The management of helical defects can be split into superior, middle and inferior thirds. For superior small defects, local skin can be advanced whereas chondrocutaneous, pre-auricular and post-auricular flaps are often used to repair larger ones. Middle defects often necessitate two-stage advancement reconstructions using composite grafts from the contralateral ear. This is due to poor local donor tissues. The inferior helix is more richly supplied than the helix allowing for mobilisation for reconstruction. It heals by secondary intention or with full thickness skin grafts. The lobule should be closed by primary intention to avoid severe contraction if skin grafts are utilised. Anterior central defects can heal well with either secondary intention or full-thickness skin grafts. The posterior auricle can generally be left to heal by secondary intention. Optimal reconstruction will balance restoration of form and function. Furthermore, understanding the anatomy behind the auricle will additionally aim to reduce recovery time, operative time, donor site morbidity and improve patient satisfaction.
Reconstructing post-resective auricular defects
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