Chapter 24: Anterior Ear

INTRODUCTION

The anterior ear has minimal skin laxity for flap repairs.¹ The goal with all repairs in this area is to maintain form and function of the ear. The anterior aspect of the ear outside the conchal bowl provides the scaffolding for the helix. Only very small defects may be closed in a side-to-side fashion. Many defects can be left to heal by second intention with excellent results. Some defects may be closed with a rotation flap. The most common closures on the anterior ear are skin grafts. Depending on the size of the defect, a full-thickness or split-thickness skin graft is used.

The main issue with this location is cartilage protrusion, which may lead to chondrodermatitis. All closures must minimise points of protruding cartilage to reduce the risk of this complication.

SIDE-TO-SIDE CLOSURE

See Video Side-to-Side Closure (Chondrodermatitis)

Advantages

• Restores normal ear structure

• Best for small defects

• Often used for treatment of chondrodermatitis nodularis of the helix (Fig. 24.1) and antihelix (Fig. 24.2)

Disadvantages

• Only possible on small defects

• Ratio of the ellipse should be at least 4:1

Technique

1. Determine the direction of the ellipse. The ideal direction is arcing down the scapha.

2. Incise the ellipse skin with a scalpel then use the surgical scissors to cut.

3. Undermine if necessary, ideally after hydrodissection using local anaesthetic.

4. For chondrodermatitis of the antihelix, remove the underlying cartilage with the skin ellipse. For side-to-side closure of defects unrelated to chondrodermatitis, the underlying cartilage is only removed if the skin cannot be pulled together side to side while the cartilage remains in place.

5. Place a few monofilament, absorbable sutures for precise approximation of the cartilage along the entire wound margin with the knots on the posterior surface.

6. Surface ...