Correspondence Address:
Ananta A Kulkarni
Department of Plastic Surgery, Padmashree Dr D Y Patil Hospital and Research Centre, Sector 5, Nerul, Navi Mumbai, Maharasthra - 400 706
India

Full Text

Sir,

A variety of techniques have been described for reconstruction of traumatic deformities of ear lobule. These broadly fall into three categories: (1) pre-auricular flap reconstruction; (2) post-auricular flap reconstruction and (3) tissue expansion using a tubed flap or Zulu method. [1]

We have used a two flap technique of converse [2] in two patients of total ear lobule loss [Figure 1]. However, we found that in both patients the final flap was inadequate [Figure 2] (due to necrosis of the distal tip of the flap of around 1 cm as a result of ischemia and infection). Hence we used a horizontal transposition flap inferior to the ear and used it to give the anterior surface of the lobule after opening the previous flap to form the posterior surface of the lobule, a second stage procedure (3 months after the 1 st stage). The base of the transpositioned flap was divided after 3 weeks and with this technique we found adequate amount of ear lobule in both the patients and that the scar also is horizontal and is hidden behind the newly constructed lobule [Figure 3] and [Figure 4].{Figure 1}{Figure 2}{Figure 3}{Figure 4}

This flap has the advantage of a well-hidden scar with the donor site providing skin of similar consistency, thickness and pigmentation. There is direct closure of the donor site and as a result hospitalization and post-operative care are kept to a minimum. We achieved an adequate amount of ear lobule reconstruction. We suggest that this flap should be used as a secondary procedure after the failed or inadequate first stage converse reconstruction as an adjuvant to conventional flap technique.

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