A Simple Modified Flip-Flop Flap for the Reconstruction of Antihelix and Triangular Fossa Defects.

Due to the three-dimensional configuration of the auricle and cartilage, surgeons encounter significant challenges in the reconstruction of auricular defects in anterior regions such as the antihelix and triangular fossa. Local flaps, skin grafting, and wedge excision are currently used in these locations. Postauricular flaps are the most common of these techniques, due to their advantages that include low morbidity, a wellhidden scar, direct closure, and good color match to the ear skin [1]. However, the lack of underlying vasculature and perichondrium may lead to graft necrosis. Moreover, wedge excision cannot be performed in patients with defects of the antihelix or triangular fossa because such patients are vulnerable to severe ear deformities. We modified a flip-flop flap to reconstruct anterior defects of the ear across the antihelix and triangular fossa. Our technique is a one-stage, random-pattern island flap surgery, and allows a shorter operation time and reduced losses at the donor site, while still leading to satisfactory treatment outcomes. Here, we describe our technique and its outcome. This study was reviewed and approved by the ethics review board of the Inje University Health Center. A 70-year-old man visited us with a chief complaint of Bowen’s disease in the right ear. The patient underwent excision of the tumor with adequate circumferential and deep margins, including the perichondrium. The defect, located throughout the antihelix and triangular fossa, was oval in shape and 2.0 × 1.8 cm in size, with exposed cartilage (Fig. 1). Under local anesthesia, we performed preoperative marking for the skin island, based on the size of the