Abstract
Many techniques have been described in the literature for the reconstruction of congenital or acquired defects of the earlobe. Most techniques for earlobe reconstruction use adjacent tissue to compose a pedicled or bilobed flap, but usually require a two-stage procedure, or need a skin graft; more rarely reconstructive methods that led to a satisfactory result and a pleasant appearance in one-stage procedure have been described. We describe a personal and geometrical modification of the double-lobed flap according to Gavello’s original technique, which allows to shape the anatomical curvature of the earlobe and to reduce the skin retraction without adding any scars or skin graft. In our opinion, the revisited reconstructive technique provides lots of advantages, improves aesthetical results and provides more natural appearance.
1
Case reports
A 60-year-old Caucasian man affected by cutaneous melanoma of the left earlobe had referred to our clinic in January 2013.
After primary surgical excision and characterization of the histopathologic features according to the International Guidelines , we planned earlobe amputation for 1-cm local wide excision and simultaneous sentinel lymph node biopsy by otholaryngologists ( Fig. 1 ).
An immediate earlobe reconstruction was performed using a modified double-lobed flap. Surgical procedure was performed under local anesthesia, with the patient in a supine position and head flexed on the right side.
The outlines of our modified double-lobed flap were marked on the skin of left infra-auricolar and mastoid region based on the shape and on the size of the contralateral earlobe ( Fig. 2 ). The flap was anteriorly based and raised with its base functioning as the anterior attachment of the earlobe. The neo-lobule was created when the harvested flap was folded on itself and stitched to the surgical auricular defect superiorly.
Our personal technique shows three important modifications of the double-lobed flap according to Gavello’s original technique. Firstly we performed multiple alternating triangular flaps ( a , b , c , d — a 1 , b 1 , c 1 , d 1 ) on the inferior edges of the bilobed flap, that act as multiple Z plasties when the flap is folded on itself ( Fig. 3 ).
This creative plan allows to shape the anatomical earlobe rim, modeling the curvature and reducing the high risk of skin retraction of the reconstructed earlobe reported in other techniques. Raising the second lobed flap smaller than the first one, is a technical detail that allows to maintain the surgical scar hidden on the posterior side.
Further, we performed a distal rectangular appendix ( C , D , C 1 , D 1 ) that allowed to maintain the retroauricolar sulcus, without the need of skin graft in a second time. Cartilage framework was not necessary. Donor site was closed by direct suture, after generous undermining of the surrounding area, as in a cervical lifting ( Fig. 4 A ).
