V-Y Advancement Flap: Aesthetic Reconstruction for Auriculotemporal Keloid Excision

Keloids are most commonly located in the ears (44.4%), followed by the thorax (33.3%), and shoulders (7.4%) [1]. Keloids, along with hypertrophic scars, are caused by an aberration in the normal wound healing process and inflict great discomfort on the patient [2]. Abnormal scars may cause pain or pruritus, disturb the range of motion, diminish sensation, or cause aesthetic deformities that may lead to significant psychosocial distress. Treatment modalities include compression therapy, cryosurgery, injections (steroids, mitomycin C, 5-fluorouracil, interferon, or platelet-rich plasma [PRP]), surgery, and postoperative radiotherapy, depending on the size and location of the keloid scars [3-6]. Auricle keloids usually are preceded by piercing, surgery, or trauma. Keloids of the ear have the potential to grow aggressively, enveloping the neighboring tissue [7]. Because the auricle is an aesthetically important portion of the facial area, treatment options must be carefully chosen to maintain a normal appearance and prevent deformity. Compression therapy or serial steroid injections are a less invasive approach, but it is difficult to obtain absolute resolution with these treatments. Excision is the most efficient method of treatment, but it is accompanied by the risk of recurrence, which surgeons constantly combat with various adjuvant therapies, and by the necessity of an immediate reconstruction of the defect, which results from a sufficient resection. In smaller lesions, the defect is usually closed primarily or with the aid of a local flap. Larger lesions require a skin graft or a more intricately designed regional flap. The disadvantage of skin grafts is that they cause color mismatch as well as additional donor morbidity [8]. Ear keloids located near the auriculotemporal sulcus require a reconstruction method that maintains the cephaloauricular angle and prevents blunting of the sulcus. Herein, we report the use of a V-Y temporal advancement flap for the excision of a keloid scar.