Weerda 1984

Larger two-layer and three-layer defects involving the anthelix and concha can be repaired with a superiorly or inferiorly based transposition flap. If necessary, the postauricular surface is covered with a rotation flap. The helical rim can be temporarily sectioned and separated (Fig. 10.3a-c). In a second stage 18-22 days later, the healed flap is divided and the helix reapproximated. The rest of the pedicle is then returned to the mastoid area (Fig. 10.3d).

Posterior Auricular Flap

a Conchal defect b Retroauricular and postauricular island flap with a subcutaneous pedicle (posterior auricular artery). c The island flap is pulled through into the defect and sutured into place (anterior side). d The secondary defect is closed by direct suture (posterior side).

a Conchal defect b Retroauricular and postauricular island flap with a subcutaneous pedicle (posterior auricular artery). c The island flap is pulled through into the defect and sutured into place (anterior side). d The secondary defect is closed by direct suture (posterior side).

Fig. 10.2 Conchal defect a Superiorly based retroauricular transposition flap with a de-

epithelialized area. b Inferiorly based transposition flap (alternative to a). c All defects are closed. Generally the pedicle is divided and inset in a second stage about 3 weeks later.

Pedicle Face Surgery

Fig. 10.3 Temporary separation of the helix for a large, three-layer auricular defect (after Weerda 1984). a Conchal defect (D). The helix is sectioned above the earlobe (arrow).

b An inferiorly based transposition flap (L) is used for the anterior repair. The posterior side is covered with a rotation flap (or thick split skin graft). c The flaps are inset.

d About 3 weeks later the transposition flap is divided and replaced, and the helix is reapproximated.

Fig. 10.4 Wedge-shaped resection (up to 2 cm of the helical rim).

a Burow's triangles are incorporated into the resection to prevent auricular distortion. b The defects are closed.

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