OF CONCHA-HELIX DEFECTS. BY JAMES K. MASSON, M.D. Mayo Clinic and Mayo Foundation, Rochester, Minnesota
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1 British Journal qf Plastic Surgery (x97z), 7,5, A SIMPLE ISLAND FLAP FOR RECONSTRUCTION OF CONCHA-HELIX DEFECTS BY JAMES K. MASSON, M.D. Mayo Clinic and Mayo Foundation, Rochester, Minnesota AFTER excision of basal cell and squamous cell epitheliomas from the helix and concha of the ear, the defect can often be sutured directly. Occasionally, however, it may be so large or in such a location that a free graft or a local flap is needed for satisfactory repair. A simple island flap of skin and subcutaneous tissue from the uninvolved postauricular surface of the concha and mastoid area has been found useful in repairing a number of such defects which involve the anterior skin and cartilage but not the posterior skin layer. TECHNIQUE The main steps of the operation are shown in Figures I-4. After excision of the lesion a flap of the same size and shape as the defect is outlined immediately behind the defect (Fig. 5). Usually the island flap involves part of the post-auricular skin and the subcutaneous tissue exposed by removal of the cartilage. The flap is completely incised around the periphery but left attached to its base. There is now a through-and-through opening in the ear. The margins of the flap are undercut and mobilised somewhat,, A FIG. I. A, Post-auricular island flap showing incision extending through ear. B and C, The flap being rolled or pulled through to the anterior surface. but this narrows the pedicle and the optimum amount of undermining is a matter of judgment. With the ear pushed back the island flap becomes visible through the defect. With a hook or forceps, the most distal margin of the flap is pulled through the defec~
2 400 B R I T I S H J O U R N A L OF P L A S T I C S U R G E R Y \ \ ) 'xt / ~2
3 SIMPLE ISLAND FLAP FOR RECONSTRUCTION OF CONCHA-HELIX DEFECTS 4OI FIG. 3- Cross section through ear at level of external auditory canal. A, Lesion in the concha. B, Lesion excised and post-auricular skin incised through operative defect. C, Post-auricular skin rolled anteriorly. A FIG. 4. Cross section through ear at level of external auditory canal. A, Remainder of flap incised and undermined. B, Flap pulled through and sutured to anterior surface of ear. C, Post-auricular donor area closed. and is sutured to the most anterior margin of it (Fig. 6). The flap is now sutured in place. ~ The donor defect is closed with nylon suture or fine interrupted chromic catgut sutures (Fig. requires excision at the upper and lower ends of this wound. dressing over the ear is necessary. entire periphery of the a running subcuticular 7); a dog-ear usually Only a light protective
4 402 ~ R I T I S H JOURNAL OF PLASTIC SURGERY Fie. 5- A, Basal cell epithelioma in concha outlined. B, Defect after excision of tumour and underlying cartilage. C, Island flap incised behind the defect. FIG. 6. A, Island flap is undermined about periphery and through defect anteriorly. B, With ear pushed back island flap fills defect. C, Flap is sutured in place. FIG. 7- A, Post-auricular defect after flap is sutured. B, Post-auricular defect closed. C, Flaps completed.
5 SIMPLE ISLAND FLAP FOR RECONSTRUCTION OF CONCHA-HELIX DEFECTS 403 The advantages afforded by the flap are mainly its ease of application and its convenience The flap is an ideal colour match and does not require the special dressing technique that is necessary for irnmobilisation of a free graft. The sutures can be FIG. 8. A, Concha defect after excision of basal cell carcinoma. B, Island flap sutured in place. C, Appearance IO months later. removed in 5 to 7 days. There has been no circulatory disturbance or unsatisfactory healing in any of the island flaps, and the final appearance has been excellent (Fig. 8). The operation can be done on an outpatient basis and does not require hospitalisation. Correspondence : The Section of Publications, Mayo Clinic, Rochester, Minnesota
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