Learn These 3 Principle of Reconstructive Design for an Ear Defect

3 Principles of Reconstructive Design for an Ear Defect

When reconstructing a Moh defect on the ear, there are 3 Principles of Reconstructive Design to consider when choosing the best repair option:

  1. Preserve external auditory canal (EAC) patency 
    • Scarring from defects of tragus, concha, or EAC may occlude the canal.
    • When cartilage is removed, risk for contraction and stenosis increases.

Goal: The goal is to preserve full patency of the EAC.  Be mindful that small reductions of the shape of the EAC can significantly affect hearing.  

2. Maintain helical rim and earlobe contour 

    • Perception of what the overall oval shape of the ear looks like, involving the helical rim and earlobe, is stronger than the more intricate contours of the anterior ear. 

Goal: Restore and preserve the volume and contour of the overall shape of the ear to help provide a better cosmetic result.

3. Restore projection of the pinna 

    • Simultaneous viewing of both ears is difficult, so minor variations in ear height or topography rarely impacts cosmesis.  However, changes in projection of the ear relative to the scalp may be more obvious.   

Goal: Minimize reduction of pinna height or shape to preserve function of the pinna, allowing the patient to rest his eyeglasses and utilize hearing aids if needed.  

 
Here's a Case Study

In this case study, this is a Mohs ear defect I recently repaired utilizing a variation of a helical advancement flap called, the Antia-Buch Flap.

🎥 Here is a helpful VIDEO showing how a true Antia-Buch Flap is performed on an identical defect.

Process and Reconstructive Design - Steps for Closure

  1. Incision is made along helical sulcus
  2. Chondrocutaneous advancement flap elevated off of perichondrium and subQ tissue undermined to the sulcus
  3. Flap advanced to test tension and reach
  4. Cartilage wedge removed from the antihelix to allow flap to advance into the defect with minimal resistance and tension
Results of Closure and One Week Postoperative Appearance

Pearls to Learn After Performing Repair:

For a recap, these are the 3 Principles of Reconstructive Design to consider when choosing the best repair option:

  1. Preserve external auditory canal patency 
  2. Maintain helical rim and earlobe contour 
  3. Restore projection of the pinna 

Considering these, I was able to maintain the full patency of the ear, recreate the the overall contour of the helical rim, and earlobe was preserved.  “Notching” was avoided.  As mentioned earlier, the perception of what the overall oval shape of the ear looks like, involving the helical rim and earlobe, is stronger than the more intricate contours of the anterior ear. Although part of the patient's antihelix was excised, the volume and contour of the overall shape of the ear was preserved to help provide a better cosmetic result.  Remember, simultaneous viewing of both ears is difficult at the same time, so minor variations in ear height or topography rarely impacts cosmesis.   

However, since the overall pinna shape was reduced, I will note to monitor the patient's ear function, assess if the ability to wear his eyeglasses is affected, and also evaluate changes in his hearing. I will also monitor any development of contraction to the ear since part of his cartilage was excised. 

Resource: Jonathan Kantor (2018). Dermatologic Surgery (1st edition).  

Advance Your Skills

As dermatology NPs/PAs, I hope this article helped you better understand surgical pearls to be mindful of when performing surgery.  Also, techniques to use to achieve the best aesthetic results for your patient.

If you found this article helpful and want to dive deeper into building your confidence in your surgical skills, I created an advanced suturing course tailored specifically for dermatology NPs/PAs that will break down how to perform these suture techniques, step-by-step.  

The course will help you minimize scarring and improve your patients’ outcomes. If this sounds like a course that will help leverage your skills, click HERE to learn more!

Until next time...

Serving with GRATITUDE,

Theresa Talens DNP, FNP-C

P.U.L.S.E. Dermatology & Procedures, Inc.

Where we believe in Precision. Ultimate Care. Leverage. Skills. Excellence.