Clinical articles
Reconstruction of skin cancer defects of the auricle

https://doi.org/10.1016/j.joms.2004.07.006Get rights and content

Purpose

This article reviews the results of reconstruction of surface defects of the auricle after removal of skin cancer, and discusses the results of the delayed reconstruction method of care and modalities of treatment.

Patients and methods

Fifty-four patients with 62 defects involving various locations on the auricle were treated. Management included direct closure, secondary epithelization, full thickness skin grafts, local flaps using direct advancement, and rotational advancement flaps using one or more stages.

Results

Nine defects were treated by direct closure with adjacent tissue, 12 defects healed by secondary epithelization, and 13 patients were treated with a full thickness skin graft. Twenty-eight defects were reconstructed with local flaps, which included the direct advancement, rotational flaps, transposition, and subcutaneous island flaps. No infections occurred.

Conclusion

Many options are available for reconstruction of auricular defects which yield acceptable results. Factors to consider before choosing a reconstructive format include size, location, and depth of the defect, patient medical history, smoking, and esthetic concerns. This review exposed that patients easily accept the “delayed” method of reconstruction. Delaying allows the surgeon time to research options for care and allows the patient choices of secondary epithelization and significantly reduced costs of care.

Section snippets

Patients and methods

The last 54 sequential patients with 62 ear cancers who were treated from 1995 to 2001 in the Facial Lesion Clinic at John Peter Smith Hospital (Fort Worth, TX) were evaluated. Generally, the skin cancers were resected in the clinic with appropriate margins based on the biopsy report, tumor behavior, and size of the lesion. One patient was referred for Mohs surgery, but most other patients did not financially qualify for Mohs resections.

Patients were not premedicated with antibiotics nor were

Results

Nine defects (less than 0.7 cm diameter) had primarily closure by directly undermining the adjacent tissue in the subcutaneous plane. Deep defects of the helical rim, up to 1.5 cm, were closed with wedge excisions. Twelve defects healed by secondary epithelization (of which 4 were on the same patient). Secondary epithelization was chosen for many small helical rim defects, conchal bowl defects, or for large postauricular/scalp excisions that would not restrict use of glasses (Fig 1). Thirteen

Patient care concerns

Some aspects of patient or clinic behavior deserve note. Several patients, who were referred to the Facial Lesion Clinic, did not understand why they were referred. Patients commonly thought that the biopsy, which the primary care physician or dermatologist performed, was the excision. Some said that the growth was gone and had healed fine. We were aware of 1 patient (from another clinic) with an ear malignancy who had a biopsy and disappeared until the metastasis evolved. Because the biopsy is

Technical concerns

Local anesthesia block with epinephrine was the method of choice for resection and some reconstructions. Epinephrine was never a cause for tissue necrosis, but reconstructive concern remains for smokers and others with pulmonary disease (Fig 6). Sensory innervation of the auricle is by cranial nerve contributions and through the branches of cervical plexus. The medial aspect of the ear is supplied by great auricular nerve (C3) and lesser occipital nerve (C2,3). Laterally, the auriculotemporal

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