Crus defects are reconstructed with a superiorly based preauricular transposition flap (Fig. 10.10a, b).
b) Small helical defect: transposition flap and bipedicle flap (Figs. 10.11 and 10.12)
First stage: A small helical defect can be reconstructed with a superiorly or inferiorly based transposition flap (Fig. 1o.11 ) and a slightly longer defect with a bipedicle flap (Fig. 10.12) supported by cartilage from the ipsilateral concha or opposite ear.
Fig. 10.10 Reconstruction of the crus.
a Superiorly based preauricular transposition flap (hairless). b The flap is sutured into the defect. The crus is shaped with two small bolster sutures tied over pledgets or silicone film.
Fig. 10.11 Small defects of the upper helix. a Small inferiorly based (1) or superiorly based (2) transposition flap (the latter from the retroauricular sulcus) is used to reconstruct the upper helix. b The flap is inset, giving it a "fish mouth" configuration along the helix.
c Use of a preauricular flap (K: cartilage strut from the concha. I: skin incision in the concha at the border of the anthelix).
Second stage: About 3 weeks later, the flaps are divided and inset into the upper and lower helix and earlobe (Figs. 10.11b and 10.12c, d).
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