A novel approach to earlobe reconstruction using the V to Y advancement flap

Abstract

Background The V to Y advancement flap offers an excellent option for reconstructing defects of the lobule and adjacent structures of the external ear. We demonstrate its utility for small defects of the earlobe including those extending to the antitragal and conchal bowl regions. To our knowledge use of this technique for earlobe reconstruction has not been reported. Methods A review of the literature was performed on the use of the V to Y flap for earlobe reconstruction. We then described its use in reconstructing lobular defects in 6 patients. All patients had a non-melanoma skin cancer involving the earlobe. All surgeries were performed under local anesthetic at a tertiary care centre in Halifax, Canada. Defects ranged in size from 1.0 to 1.4 cm. All defects were reconstructed with only a V to Y advancement flap. Patient photographs were taken intra-operatively and post-operatively. For all patients, satisfaction of the final aesthetic result was assessed on a 10 point scale in follow-up at 6 months. Results A review of the literature did not reveal any reports of the V to Y flap used in isolation for lobular reconstruction. At our centre from 2018 to 2020, this method was well tolerated under local anesthetic in 6 patients with non-melanoma skin cancers of the earlobe. All patients reported an aesthetically satisfying result at 6 months with scores ranging between 8 and 10. Scarring in all cases was minimal. Conclusion The V to Y advancement flap is a simple technique for reconstructing small defects of the lobule. This method is technically straight-forward, poses minimal risk to the patient, and in our experience, yields a favourable cosmetic outcome. Graphical abstract

Immediate Ear Lobule Reconstruction After Melanoma Resection

“…Although other reports demonstrate reconstruction solely with local skin flaps, this method is prone to shrinkage and contracture, and ought to be a last resort when cartilage banking is unfeasible. [3][4][5][6] Our novel technique with a contralateral cartilage graft, local skin graft, and fat transfer reconstructed the lobule without delay. This granted a rare surgical opportunity to concurrently form a direct template of the pre-excised lobule and then sculpt an identical replacement using cartilage graft.…”

“…Compared with total ear reconstruction, lobule reconstruction has scantly been reported. [3][4][5][6] These select publications primarily address congenital abnormalities or trauma defects, and utilized local skin flaps with or without adjunctive skin and cartilage grafts. Previously reported cases of lobule excision due to cancer were either delayed reconstructions or the cancer did not warrant a complete lobule resection and advanced skin flaps were sufficient.…”

“…Key Words: avulsion, pediatric, replantation, scalp S calp avulsions are rare but quite morbid clinical manifestations. 1 The fact that the scalp is the only hairbearing part of the body with no substitute, all efforts have been applied for a successful replantation despite the technical difficulties 2 since the first microsurgical description of replantation by Miller et al 3 Although the mechanism of injury and the scenario are generally the same as in adults, pediatric patients have some different perioperative and postoperative difficulties. Psychosocial stress that will develop as a result of an unsuccessful scalp replantation is greater than in adults.…”

“…Microtia reconstruction and auricle reattachment have previously been reported on, but scantly on the topic of complete lobule reconstruction, especially due to oncological resection. [3][4][5][6] The few reports on complete reconstruction utilized costal, septal, or ipsilateral conchal cartilage, and varying flap procedures and stages. In the current report, we describe our novel technique of immediate ear lobule reconstruction after melanoma excision utilizing contralateral conchal cartilage graft, skin graft, and fat transfer.…”

“…Microtia reconstruction and auricle reattachment have previously been reported on, but scantly on the topic of complete lobule reconstruction, especially due to oncological resection 3–6. The few reports on complete reconstruction utilized costal, septal, or ipsilateral conchal cartilage, and varying flap procedures and stages.…”