Successful Reconstruction of a Large Helical Rim Defect Using Retroauricular Artery Perforator-Based Island Flap

Abstract

The retroauricular flap has many applications, providing coverage for various portions of the face as a pedicled flap or a free flap. The retroauricular skin, having similar attributes to the facial skin, is an ideal donor site for facial reconstruction. Also, the donor site can be primarily closed without morbidity, which is also an advantage. In this article, a large helical defect resulting from a traumatic amputation was reconstructed using the contralateral conchal cartilage graft and a retroauricular perforator-based island flap. Using the "perforator pedicled propeller flap" concept, no meticulous dissection around the perforator was done, and the flap was elevated only until sufficient rotation arc was achieved. There was some degree of venous congestion on the flap for 3 days postoperatively, but the flap survived completely. By using the conchal cartilage from the contralateral side, the final contour of the ear was maintained aesthetically. The flap had some bulkiness on the posterior side of the auricle where it was transposed, but it was inconspicuous on frontal or lateral view because the conchoscaphal angle had not changed. The patient was satisfied with the aesthetic results. The retroauricular flap is useful for resurfacing any portion of the ear, and by using the propeller flap method, significant reduction in operative time can be achieved without compromising the final results.