Conchal bowl chondrocutaneus transposition flap used in loss of upper ear

CHICAGO — Researchers reconstructed the upper third of a man’s ear by creating a conchal bowl chondrocutaneous transposition flap, according to study results presented at the American Society for Dermatologic Surgery annual meeting.

“It’s an ideal flap reconstruction for patients who have lost the entire upper third or upper half of the ear that’s full thickness,” Joseph Sobanko, MD, a researcher on the study presented as a poster abstract, told Healio.com. “It’s a one-stage reconstruction with a really reliable blood supply.”

Joseph Sobanko

The researchers studied a man aged 77 years who had Mohs micrographic surgery for squamous cell carcinoma. The procedure resulted in a full-thickness loss of the upper third of his right ear in addition to soft tissue loss of the antihelix and middle helical rim. By transposing a full-thickness chondrocutaneous flap to the recipient site, an axial flap based on a perforator vessel of the superficial temporal artery at the conchal bowl was created to reconstruct the upper third of the ear.

A full-thickness skin graft was used to repair the resulting donor-site defect. Remaining helical rim, scaphoid, antihelical and posterior cartilage defects were covered with a post-auricular interpolation flap.

“Abnormalities of the superior helix are readily apparent to the casual observer,” the researchers wrote. “Functionally, the superior helix acts as a platform for glasses. Loss of this platform can significantly decrease a patient’s quality of life.”

Harvesting large cartilage grafts from the contralateral ear or costal cartilage were other reconstructive options, but would involve lasting donor site morbidity or risks such as pneumothorax, the researchers wrote.

“The conchal bowl chondrocutaneous transposition flap produces an elegant reconstruction of the superior ear with minimal donor site morbidity,” the researchers concluded. “It provides a stable base for the patient’s glasses to rest and recreates the shape and contour of the helical rim.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.