Reconstruction of Cutaneous Defects of the Ear Using the Post-Auricular Reservoir: A Systematic Review

September 2020 | Volume 19 | Issue 9 | Original Article | 883 | Copyright © September 2020


Published online August 14, 2020

Brandon Worley MD MSUa, Joel L. Cohen MD FAAD FACMsb,c

aDepartment of Dermatology, Division of Cutaneous and Aesthetic Surgery, Northwestern University, Chicago, IL bAboutSkin Dermatology, Greenwood Village, Denver, CO cUniversity of California Irvine, Irvine, CA

Abstract
Background: An approach to the reconstruction of the ear requires consideration of gross anatomy, blood supply, and size of the defect to select the repair. While skin grafts provide a convenient option for many helical and conchal defects, using posterior auricular reservoir can preserve ear contour and hide the scar for an aesthetic closure.

Purpose
: To illustrate the versatility of the post-auricular and mastoid skin reservoir for auricular repairs after surgical removal of a cutaneous malignancy.

Data Sources
: MEDLINE, EMBASE, and Cochrane Databases were searched for all techniques using a post-auricular approach for auricular repair of surgical defects in the context of cutaneous oncology until November 2019.

Data Synthesis
: The most well-described techniques of pull-through, post-auricular pedicle and Banner flaps were selected for in-depth review. Illustrative cases and a summary of the spectrum of techniques from case reports are provided.

Limitations
: Few randomized trials exist to compare the outcomes of the flaps to determine a preferred flap technique.

Conclusions
: A post-auricular approach for repair of auricular defects can provide a reasonable option for single and multi-staged closure to create an excellent aesthetic outcome while hiding the donor site. More prospective data is required to determine the overall best approach.

J Drugs Dermatol
. 2020;19(9):883-888. doi:10.36849/JDD.2020.5106

INTRODUCTION

The anatomy of the ear poses several reconstructive challenges. Cutaneous and cartilaginous landmarks and topographical rises and convexities and concavities form the overall aesthetic of the ear. When approaching post-surgical defects, the location of the defect and cartilage involvement dictate the reconstructive technique. An approach to ear reconstruction utilizing post-auricular and mastoid skin is most advantageous in two scenarios: (1) cutaneous defects of the helix and post-auricular surface or (2) full-thickness defects and those where a tunneled flap can be utilized (Figure 1). Sourcing the reconstruction from this area fully hides the scar left in the donor site, thereby reducing surgical morbidity. Though post-auricular skin is a classic harvest site for full thickness skin grafts (FTSG), repurposing this skin for flap or pedicle-based closures can lead to an aesthetically pleasing result without nearly as much concern for graft vitality. The graft approach is particularly less well-suited for the root of the helix and ear lobe. These locations often require anterior or inferiorly-based flaps for the best result, although we will demonstrate how an interpolation flap can benefit the lobe as well. Post-auricular flaps can present a more complex challenge than anteriorly-based flaps or skin grafts, as we discuss. Still, their utility in ear reconstruction is worthy of consideration. We will detail the reconstructive options that are best supported by evidence with a post-auricular approach to ear reconstruction. Our aim is to demonstrate the versatility of the post-auricular reservoir to reconstruct many of the surfaces of the ear. Illustrative cases and an index of post-auricular reconstructive options that are reported in the literature are provided.

METHODS

Data Sources and Study Selection
We conducted a search of the literature for repair options using a post-auricular approach for dermatologic surgical defects of the ear after a cutaneous malignancy removal. Consultation with a librarian was sought prior to the search. We searched MEDLINE, EMBASE, and Cochrane Review Databases from first inception until November 2019 for available clinical trials, cohort studies, case series, and case reports. Search results were narrowed first by title, followed by abstract, and then full texts were reviewed. All references from review articles were evaluated for eligible studies. Consideration for inclusion was given if an article described or compared reconstructive skin closure techniques based upon the post-auricular skin.