Ear Reconstruction after Mohs Cancer Excision: Lessons Learned from 327 Consecutive Cases

Abstract

Background: The ear serves many functional and aesthetic purposes, and its complex structure presents a notable challenge for reconstruction. A paucity of objective data and analysis on reconstruction of acquired ear defects remains. The goal of this study was to evaluate all ear reconstructions and the lessons learned over the past decades in treating these complicated defects in a large clinical Mohs reconstruction practice. Methods: A retrospective analysis of consecutive patients who underwent ear reconstruction after Mohs cancer excision from 2004 to 2018 performed by the senior author (J.F.T) was conducted. Data regarding patient demographics, oncologic type, treatment, defect characteristics, reconstructive modalities, number of stages, and complications were collected and analyzed. Results: Three hundred twenty-seven patients underwent ear reconstruction. Defects most commonly involved the superior one-third of the helix and the antihelix. Approximately half of the patients’ defects were reconstructed with full-thickness skin grafts, and approximately one-third of the patients’ defects required flap reconstruction. There were 30 complications (9 percent), ranging from partial flap loss to cancer recurrence. There was no difference in complication rates in elderly patients compared with the younger cohort. Conclusions: Optimizing results when reconstructing ear defects is challenging, and there are multiple preoperative variables to consider. Ear reconstruction is safe in an outpatient setting, and age should not preclude patients from undergoing reconstruction of ear defects. The lessons learned from the past decade of ear reconstructions are demonstrated, and an algorithmic approach to treating these defects allows for a safe and reproducible method for reconstructing acquired ear defects. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

A full‐thickness skin graft forms a new vermillion lip following surgical repair suggesting metaplasia

“…Local mucosal advancement flaps are favored for vermillion defects. Skin grafts are rarely employed due to concerns regarding texture, color, and impaired imbibition due to movement 3 . If choosing to repair by graft, then FTSGs generally show less contracture than split thickness skin grafts, and harvesting skin from the trunk is favored 4 .…”

“…Skin grafts are rarely employed due to concerns regarding texture, color, and impaired imbibition due to movement. 3 If choosing to repair by graft, then FTSGs generally show less contracture than split thickness skin grafts, and harvesting skin from the trunk is favored. 4 A small amount of contracture can be expected, and the graft size should be created slightly larger than the defect to be repaired.…”

Nasal Reconstruction after Mohs Cancer Resection: Lessons Learned from 2553 Consecutive Cases

“…As previously demonstrated, continued anticoagulation use throughout the reconstruction has limited impact on outcomes or complication rates. 17,27,28 However, smoking and age older than 75 years are strong risk factors for complications and must be considered when planning reconstruction. Although older age was associated with greater complications in this large cohort, our previous investigation of paramedian forehead flaps found no association between increased age and complications, preserving its role as a reasonable reconstruction in the elderly.…”

Reconstruction of Full-Thickness Helical Defects Using a Superior Auricular Artery-Based Postauricular Chondrocutaneous Flap

“…Auricular defects resulting from trauma, human bites, burns, and surgical resection of skin pathologies most commonly occur in the helix 1–14 . Helical defects typically involve the full thickness of the skin and cartilage, resulting in auricle asymmetry and significant esthetic, functional, and psychosocial issues, due to the highly visible location of the helix and its structural support role when wearing glasses, masks, and piercings 9,10,14,15 …”

“…The helix has a prominent, visible, and 3-dimensional complex anatomy along the upper two-thirds of the auricle, comprising a marginal located helical rim, folded helical sulcus, and c-shaped curvature between the scalp and earlobe. Reconstruction of full-thickness helical defects presents considerable challenges 1,4,6,7,10,12–14,16–18 . The goals of helical reconstruction are to provide ‘like tissue’ reconstruction with similar color, texture, and thickness; repair of the 3-dimensional cartilage framework for stable structural support; and normal auricle dimensions and anatomical landmarks in a 1-stage reconstruction 4,6–8,10–13,17,19 …”