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There falls into the hands of every reconstructive surgeon a certain group of cases in which postauricular defects have been operated on repeatedly with little or no success. These defects may be the result of uncontrolled infection, of incomplete operation on the mastoid, such as simple antrotomy and poorly executed radical mastoidectomy, or, as in one case which we observed, of the spontaneous perforation of an untreated diseased mastoid.The resulting unsightly defect is manifested as a depression in the region of the former mastoid prominence, covered wholly or in part by a thin, reddened and contracted scar, which is usually painful in varying degrees and is further made an annoyance by a discharge.With the demands on the modern plastic surgeon becoming more and more exacting, the need was felt for a review of this problem. The anatomic and surgical questions presented were reconsidered in order to establish some operative principles to insure, as far as possible, satisfactory functional and cosmetic results. REVIEW OF THE LITERATUREZoufal * in his description of the first radical mastoidectomies con¬ sidered a permanent postauricular opening essential. This was dis¬ figuring. Epithelization was allowed to take place from behind the ear rather than encouraged by splitting the membranous external auditory meatus after immediate closure of the wound, as is now commonly done. The endaural approach, revived by Lempert,2 gives excellent results from the cosmetic point of view.From the