Reconstruction of the conchal bowl and external auditory canal.

A 46-year-old man was admitted for management of a basal cell carcinoma of the right ear. He had first noticed the lesion 4 years earlier. The nodular, ulcerated growth involved the conchal bowl and the external auditory canal (figure, A). With the patient under general anesthesia, the tumor was excised with circumferential and deep margins (3.5 x 2 x 1 cm), which included the underlying conchal and external canal cartilage (figure, B).

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Reconstruction of the conchal bowl and the meatus poses a surgical challenge. Healing by secondary intention or by the use of skin grafts sometimes results in distortion of function or the anatomic structure. In this case, the area was reconstructed with a postauricular flap. An axial pattern flap was designed along the vascular axis of the posterior auricular artery and its branches. The lobule of the ear was detached to transpose the tissue from the retroauricular region to the anterior auricular surface. The flap was trimmed to fit the contour of the defect and anchored by interrupted sutures (figure, C). The donor site was closed primarily, creating a new sulcus.

The single-stage reconstruction in the absence of a donor-site deformity reduced the postoperative morbidity and provided favorable aesthetic results. Follow-up at 13 months revealed a patent external auditory canal and no evidence of recurrence of the disease (figure, D).

Suggested reading

Furuta S, Noguchi M, Takagi N. Reconstruction of stenotic external auditory canal with a postauricular chondrocutaneous flap. Plast Reconstr Surg 1994;94:700-4.

Kolhe PS, Leonard AG. The posterior auricular flap: Anatomical studies. Br J Plast Surg 1987;40:562-9.

Suma Susan Mathews, DLO, MS; Shiby Ninan, MS, Mch

From the Department of ENT (Dr. Mathews) and the Department of Plastic Surgery (Dr. Ninan), Christian Medical College, Vellore, Tamil Nadu, India.