Answer:
When managing acute auricular trauma, initial meticulous reapproximation of tissues and appropriate wound care greatly facilitates the reconstructive task ahead. Likewise, the innovative utilization of residual local tissues in a post-traumatic deformity greatly simplifies the reconstruction and contributes to a pleasing outcome.
Contralateral Conchal Cartilage
A variety of tissues are available to provide the structural support required for an auricular reconstruction. Although the quantity of cartilage needed to fabricate a total ear framework necessitates the use of costal cartilage, rarely is one compelled to employ this tissue in a small, partial auricular reconstruction. Because it is often possible to utilize an auricular cartilage graft, which is obtained most frequently from the contralateral concha under local anesthesia, the correction of partial losses is less extensive than the procedures to correct total auricular losses. Auricular cartilage, used as an orthotopic graft in ear reconstruction, is superior to costal cartilage in that it provides a delicate, flexible, thin support.
The conchal cartilage graft can be obtained by a posteromedial incision, or through an anterolateral approach. The latter, performed through an incision several millimeters inside the posterior conchal wall to inferior crus contour line, is a simple method of obtaining a precise cartilage graft with direct visual exposure .
Ipsilateral Conchal Cartilage
For certain partial reconstructions, it is more advantageous to employ an ipsilateral than a contralateral conchal cartilage graft. However, it is imperative that an intact antihelical strut be present to permit removal of an ipsilateral conchal cartilage graft without subsequent collapse and further deformity of the ear.
An ipsilateral conchal cartilage graft is particularly advantageous when a retroauricular flap is being raised to repair a major defect in the helical rim. Elevation of the flap provides the required conchal cartilage exposure without the necessity of an additional incision, and removal of this cartilage graft subsequently lowers the ear closer to the mastoid region. In effect, it produces a relative gain in length, thereby enabling the flap to cover the cartilage graft once it is spliced onto the rim and eliminating the need for a skin graft in the flap’s donor bed.
Furthermore, the ipsilateral concha is used occasionally as a composite flap of skin and cartilage. This innovative technique, proposed by Davis, is applicable to defects of the upper third of the auricle; again, it is employed only when the antihelical support remains intact.
Chondrocutaneous Composite Graft
In certain conditions, a composite graft can effectively provide the supportive tissue required for a reconstruction. The success of these grafts is greatly enhanced by removing a portion of the posteromedial skin and cartilage, thus converting part of the “wedge” to a full-thickness skin graft that is readily vascularized by a recipient advancement flap mobilized from the loose retroauricular skin adjacent to the defect . A strut of helical cartilage is preserved within the graft to maintain contour and support.