DS12: Reconstructing a challenging defect of the antihelix and scapha of the ear: how rolling over before Antia and Buch can help

Hayley Smith and Walayat Hussain

Leeds Teaching Hospitals, Leeds, UK

A 66-year-old man underwent Mohs tumour extirpation of an ill-defined, sclerotic basal cell carcinoma located on the upper third of his left antihelix. Tumour-free margins were achieved after two stages, resulting in a 1·9 × 2·8 cm surgical defect involving complete loss of the cartilaginous portion of the defect that encompassed the helical rim but with an intact postauricular surface. The patient expressed a very high level of concern about his ability to wear his spectacles, as well as the overall shape and symmetry of the left ear vs. his unaffected right ear. The patient also declined a two-staged procedure. We therefore opted to reconstruct his ear by ‘rolling over’ the postauricular skin to resurface the exposed cartilage and perichondrium along the antihelix and scaphoid fossa. A strip of skin extending along the posterior ear to the sulcus, corresponding to the height of the ‘rolled-over’ portion of skin, was then de-epithelialized. Having achieved meticulous haemostasis, a classical helical rim advancement flap of Antia and Buch was performed. The flap was incised, elevated by sharp and blunt dissection to the postauricular sulcus, advanced and inset using buried monofilament vertical mattress sutures and polypropylene surface stitches to be removed 1 week postoperatively. Despite the complex surgical defect in our patient’s ear, the long-term aesthetic result was very favourable. Furthermore, although a significant helical rim advancement was required, due to significant laxity in the ipsilateral earlobe, no obvious asymmetry was evident between the ears. Our reconstruction also enabled our patient to continue to wear his spectacles.