The staged retroauricular to auricular direct pedicle (interpolation) flap for helical ear reconstruction

Background: A significant soft-tissue defect involving the helix of the external ear may present a difficult challenge to repair. Objective: We describe our experience with the staged retroauricular to auricular pedicle flap for repair of soft-tissue defects with exposed cartilage of the helix of the ear. Methods: The staged pedicle flap was used to repair 26 helical ear defects after excision of basal cell carcinoma (n = 16), squamous cell carcinoma (n = 3), and melanoma (n = 7). Results: Defect size ranged from 1 x 2 cm to 4 x 6 cm (average 2.4 x 3.3 cm). Defects involved the superior helix in 12 patients, mid helix in 11, end inferior helix in three. No cases of infection or flap necrosis occurred. Conclusion: The staged retroauricular to auricular pedicle flap consistently provides a good to excellent functional and cosmetic outcome when performed on properly selected helical ear defects.