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REPAIR OPTIONS: PREAURICULAR AREA
Side-to-side closure
Second intention (refer to Chapter 2)
Burow’s exchange advancement flap
Transposition flaps (rhombic or parabolic design)
Subcutaneous island pedicle flaps
Skin grafts
Preferred option when standard side-to-side closure is not possible
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The preauricular area is an extremely common location for skin cancers. The area has the potential to utilise skin laxity from the cheek and jowls; however, the degree of skin laxity is highly variable depending on the age of the patient. A side-to-side closure in a vertical orientation is often possible. Other options include advancing skin from the lower cheek, or for deeper defects, a subcutaneous island pedicle flap may be utilised.1
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For defects located just anterior to the lower third of the ear, a transposition flap from the jawline or retroauricular sulcus may be an option. On rare occasions very large defects may require a skin graft. Very large neck rotation flaps are beyond the scope of this book, as they are best performed with general anaesthesia.
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The parotid gland is protected by the parotid fascia, but it can be relatively close to the skin in the lower preauricular area and the angle of mandible. The lobular appearance of the parotid gland can simulate the subcutaneous fat.2 Care should be taken to avoid transecting parotid tissue when incising flaps and undermining in this area. Although rare in cutaneous surgery, complications of transecting parotid tissue can include Frey’s syndrome (gustatory sweating), sialocele and salivary fistula.3,4
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Design a vertical ellipse. The ellipse can be drawn so the lateral line is directly anterior to the ear. The medial line is drawn around the defect. The different lengths of the lines can be sewn out using the ‘rule of halves’ principle or with a dog-ear repair.
Undermine the medial edge and slightly under the lateral edge. After haemostasis is achieved, absorbable sutures can be placed followed by superficial sutures.
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