[Tunnelized preauricular transposition flap for reconstruction of anterior auricular defects].

Actas Dermosifiliogr. 2008;99:157-69 161 To the Editor: Reconstruction of the anterior aspect of the auricle of the ear after oncologic surgery is often complicated and requires imagination when planning the surgical technique. The techniques usually used are direct suture, grafts, second-intention healing, and postauricular pedicle flaps, in particular the “revolving door” flap.1 We describe an ingenious preauricular transposition flap that is situated in the defect through an incision in the posterior aspect of the antihelix. The patient was an 81-year-old man with a history of chronic bronchitis who was seen for extensive lesions on the anterior and posterior aspects of the auricle of the ear that were clinically and histologically compatible with squamous cell carcinoma and had been present for more than 1 year. We performed excision of both lesions including the perichondrium and respecting the cartilage; the defects were repaired using 2 preauricular and postauricular transposition flaps. We first marked the flaps on the skin and then administered local anesthesia (bupivacaine with epinephrine) using the circumferential technique, infiltrating the whole circumference of the auricle starting at the lobule. For reconstruction of the defect of the antihelix, we designed a transposition flap using the preauricular region. The surface that was to be interposed in the auricular area was de-epithelialized (Figure 1). The flap was dissected above the superficial temporal vessels and passed through an incision on the posterior aspect of the antihelix to situate it over the defect (Figure 2). Finally, we used silk to suture the flap and preauricular region (Figure 3). For reconstruction of the posterior defect, we designed a rotational postauricular flap that was dissected and sutured to the defect. Surgery to the auricle of the ear is complex, particularly when the disorder affects the anterior aspect, which is more visible and therefore requires better esthetic results; this is even more complex if there is a second tumor on the same auricle. When the tumor is situated on the antihelix, reconstruction depends on the size of the resulting defect and on whether cartilage or perichondrium has been excised. Small defects can be sutured directly, sacrificing the helix, or if the perichondrium is intact, by secondintention healing or a graft. In defects of more than 1 cm that do not involve the perichondrium, we use these same techniques; if cartilage has been excised, postauricular flaps are used either as a revolving door island flap or as a transposition flap in 2 stages.2,3 In our case, we describe a novel flap that, in a single surgical procedure, provides skin with a similar color and texture to the defect. The flap is well vascularised and has a good consistency and can be used for defects with or without alterations of the cartilage and perichondrium, particularly when we cannot use postauricular flaps or grafts. Tunnelized Preauricular Transposition Flap for Reconstruction of Anterior Auricular Defects