Chondrocutaneous Advancement Flap and Postauricular Skin Flap: An Effective Combination for Large Helical Rim Defect Reconstruction.

Abstract

Background: Defects of the ear helix are a frequent challenge in plastic surgery, with more than 5% of all skin cancers occurring in this region. The Antia-Buch flap is a single-stage reconstruction technique utilizing chondrocutaneous flaps for helix repair. However, for defects exceeding 2 cm, it can lead to auricular distortion. To address this limitation, we propose a modified Antia-Buch technique combining chondrocutaneous advancement with a postauricular skin flap to optimize outcomes.

Methods: A retrospective review was conducted of 15 patients who underwent our modified Antia-Buch flap procedure between 2019 and 2022. This approach incorporated chondrocutaneous advancement for primary defect closure and a postauricular skin flap for improved contouring. Functional and aesthetic outcomes were assessed using a questionnaire developed in collaboration with a clinical psychologist. The questionnaire evaluated surgical satisfaction, cosmetic results, self-image, and social integration postreconstruction.

Results: No complications, including ischemic necrosis or the need for surgical revision, were observed in any case. The technique demonstrated excellent vascularity, with no occurrences of flap failure. Patient-reported outcomes revealed high satisfaction rates, with no evidence of self-image distortion or social barriers. Aesthetic results were rated as superior, with minimal risk of auricular distortion even for larger defects.

Conclusions: The modified Antia-Buch technique is a reliable and effective method for helical rim reconstruction, particularly for defects larger than 2 cm. It offers technical simplicity, low complication rates, patient convenience, and excellent cosmetic outcomes, making it a preferred option for many auricular defect reconstructions.