Reconstruction of Helical Defects with Preservation of Auricular Size

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.

Bolster Tie Over For Pinna Haematoma

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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