Answer:
Upper third defects may be reconstructed by five major methods. Usually, minor losses are confined to the rim and are repaired either by helical advancement, or by a readily accessible preauricular flap. Intermediate losses of the upper third are repaired with a banner flap, as described by Crikelair. This flap, based anterosuperiorly in the auriculocephalic sulcus, is used in conjunction with a small cartilage graft to ensure a good long-term result. Major losses in the superior third are most successfully reconstructed with a contralateral conchal cartilage graft, as classically described in 1955 by Adams. When utilizing this technique, it is imperative that the cartilage graft be anchored to the cartilaginous remnant of the helical root by means of a suture placed through a small incision at that point. This step prevents the cartilage graft from “drifting” and ensures helical continuity. Should the existing skin be unfavorable for the above technique, the entire concha may be rotated upward as a chondrocutaneous composite flap on a small anterior pedicle of the crus helix. Technically, it is a demanding procedure and is restricted to individual instances in which a large concha exists.