Surgical Defects of the Ear

By Perry Robins, MD


Clinical Bottom Line:

One should start with a smaller defect, then progressing to a larger size defect, as one gains experience in the technique.

Removal of a skin cancer involving the helical rim can result in a thru-and-thru defect. Not infrequently, a basal cell carcinoma involving the perichondrium will spread a greater distance laterally than appears clinically. Rarely does basal cell carcinoma invade cartilage, but instead spreads laterally between the cartilage and the dermis. It is our goal in repairing these defects to preserve the maximum amount of auricle possible. There are two major techniques for correcting this defect.

One is the wedge resection, which will remove a considerable amount of tissue and reduce the size of the ear. An alternative and superior approach is to do a bilateral chondrocutaneous advancement flap. The latter is superior because it leaves the size of the auricle intact.

Technique: This approach of doing a bilateral advancement flap is most advantageous when the defect measures less than 1/3 of the circumference of the helix. The area is anesthetized both on the interior and anterior surfaces using lidocaine without epinephrine. A thru-and-thru incision is made to free up both arms of the advancement flap. The tissue is stretched and brought together with one or two tacking stitches using 5-0 nylon. The remaining surgical lines both anterior and posterior using 5-0 running nylon suture are left in place for 10 days.

The sutures are then removed, yielding a good cosmetic result with the ear being approximately the same size as prior to the surgery. If tension on the flaps is too great, one can remove two small triangles at the base of the flap, thus reducing the distance to enable you to join the two arms together without unnecessary tension.

Surgical defect

Bringing the two helical flaps together

Posterior view

Final cosmetic result

About the author

Perry Robins, MD

Perry Robins, MD, is Professor Emeritus of Dermatology at the New York University School of Medicine. Dr. Robins has practiced medicine for over 40 years and has treated more than 47,000 skin cancer patients. Over 40% of the doctors who specialize in skin cancer were either trained by Dr. Robins himself or by doctors he has trained. He has lectured in 37 countries in 4 languages. Dr. Robins is the founder and President of The Skin Cancer Foundation, a national organization dedicated to the research of skin cancer and public and medical education. Dr. Robins is also the founder/president of the International Society of Dermatologic Surgeons, founder/former-president of the Mohs Society, and former-president of the American Society of Dermatologic Surgery.

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