Chapter 25: Posterior Ear

INTRODUCTION

The surgeon has several repair options for surgical defects on the posterior ear as a result of the laxity of the skin in the postauricular sulcus and the relative ease of undermining on the posterior ear.¹

Primary closure is preferred when defects are small to medium sized and near the postauricular sulcus. Transposition and rotation flaps are used when defects are medium sized and located away from the sulcus. Island pedicle flaps are most reliable when used for defects located on the mid posterior ear near the sulcus where they can incorporate a myocutaneous pedicle from auricularis posterior muscle. Second intention healing, full-thickness skin grafts and split-thickness skin grafts are frequently used for large and very large defects, often in combination with other repairs.

In choosing the most suitable reconstruction, the surgeon should consider the secondary defect as well as the primary defect. Scarlines are typically well hidden at this site and some posterior ear retraction produces less aesthetic morbidity compared to pulling the ear forward. However, particular attention should be given to preserving the contour of the postauricular sulcus, as web contractures can interfere with the positioning of hearing aids and spectacle arms.

Adequate lighting and the help of an assistant are recommended due to the inherent anatomical difficulties with access at this site. The risk of postoperative bleeding and haematoma formation can be reduced by performing meticulous haemostasis and by placing deep sutures so as to minimise dead space.

SIDE-TO-SIDE CLOSURE

See Video Side-to-Side Closure

Advantages

• Simplest local repair with the lowest risk of postoperative bleeding

• Suitable for small- to medium-sized defects over, or near, the postauricular sulcus

• Can be combined with skin grafts or second intention healing (see Fig. 25.1)

• Minimal need for undermining

Disadvantages

• Can pull the ear back

• Can reduce the depth of the postauricular sulcus which may interfere with the proper fitting of glasses

Technique

1. Design and incise an ellipse along, or parallel to, the postauricular sulcus.

2. After haemostasis is achieved, some surgeons place absorbable sutures. Closing the defect ...