Clinical articlesReconstruction of skin cancer defects of the auricle
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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