Reconstruction of auricular conchal defects with local flaps
Open accessAbstract
Reconstruction of the auricular conchal cavity is relatively difficult because of its unique structure, shape, and location. We compared different methods of repair of the auricular concha to determine the method that would cause the least injury to the donor site.The method selected was based on the location and size of the defect. If the defect was located in the upper part of the concha, or if the defect was >15 mm in diameter, we used a post-auricular subcutaneous pedicle island flap that was pulled through a post-auricular sulcus tunnel to cover the wound. If the defect was located in the lower part of the concha and was <15 mm in diameter, we used a pre-auricular translocation flap that was passed through the intertragic notch to cover the wound. The donor site was closed primarily. All flaps survived well and any scars associated with the surgery were unnoticeable. No tumor relapse or metastasis was observed over a mean follow-up period of 35 months. All patients were satisfied with the outcome.The periauricular flap technique chosen for reconstruction of skin defects in the auricular concha depends on the size and location of the defect. With appropriate flap selection, excellent functional, and aesthetic outcomes are achieved.
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The revolving door flap could be the reconstructive procedure of choice for the auricular concha following skin cancer excision, based on low risk of necrosis, infection, and postoperative hemorrhage and excellent aesthetic outcomes.
“Qualitative synthesis of the results concluded that the revolving door flap could be the reconstructive procedure of choice for the auricular concha, following skin cancer excision.”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The Results report no complications and good aesthetic outcomes after malignant-tumor excision, but these findings concern the study’s postauricular subcutaneous pedicle island and preauricular translocation flaps. The Discussion mentions the conventional revolving-door flap only as an earlier technique; the Abstract says flap choice depends on defect size and location, not that the revolving-door flap is the procedure of choice. The paper does not report a qualitative synthesis or specifically assess postoperative hemorrhage. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe revolving door flap has excellent survival rates.
“Furthermore, this flap has excellent survival rates, as all six studies recording flap necrosis incidence found no cases of this complication [3,4,5,6,8,9].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The Results (page unavailable) report no complications, including flap necrosis, among 13 postauricular island flaps and seven preauricular translocation flaps. The Discussion identifies the conventional revolving-door flap as a related technique, but this paper does not report outcomes for six studies or establish that its own flaps were the conventional revolving-door flap. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSTSG may be used as an alternative to the revolving door flap for conchal bowl reconstruction.
“STSG may be used as an alternative.”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The Introduction states that partial-thickness skin grafts have been used to reconstruct auricular defects and discusses skin-graft complications in the conchal cavity. It does not specifically identify split-thickness skin grafting as an alternative to the revolving-door flap for conchal bowl reconstruction; the comparison listed in the References concerns a full-thickness graft. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe overall aesthetic results of the revolving door flap ranged from excellent to moderately satisfactory, with the majority at the better end of the spectrum.
“its overall aesthetic results ranged from excellent to moderately satisfactory, the majority gathering at the better end of the spectrum [1,3,6,7,9].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The Results (page unavailable) report good aesthetic outcomes for the flaps studied, which supports the favorable end of the claim. But the paper gives no ratings from excellent to moderately satisfactory or distribution of ratings, and its Discussion mentions the conventional revolving-door flap as a previously described technique rather than reporting those outcomes for it. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAmong studies reporting complications of the revolving door flap, only Talmi et al. reported one case of infection after 11 flaps (9.1%), while other more recent studies found no cases of infection.
“Talmi et al. reported only one case of infection after performing 11 revolving door flaps (9.1%), whereas other more recent studies (Zhu (2016), Iljin (2018), Iljin (2016), Dyson (2019)) documenting this complication did not find any cases of infection [4,6,7,8,9].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The Results report no complications, including infection, after 13 postauricular subcutaneous pedicle island flaps and seven preauricular translocation flaps. But the Methods describe the postauricular flaps as pulled through a slit, while the Discussion mentions the conventional revolving-door flap separately; our copy does not establish that Zhu’s flaps were revolving-door flaps. Zhu also does not report Talmi’s infection rate. (LLM, conf=0.83)
Experimental — accuracy not yet measured
The revolving door flap has little tendency to develop infections.
“It may be concluded that the revolving door flap has little tendency to develop infections.”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The Results report no complications, including infections, among defects repaired with the study’s PASPI and PAT flaps. The Discussion mentions the conventional revolving-door flap, but the paper does not report an infection rate for that specific technique, so the claim extends beyond its findings. (LLM, conf=0.78)
Experimental — accuracy not yet measuredNo cases of necrosis or failure of the flap or graft occurred in any of the six papers that examined this complication for the revolving door flap.
“Likewise, necrosis or failure of the flap or graft did not occur in any of the six papers that contemplated this complication [3,4,5,6,8,9].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The Results (page not provided) report no complications, including flap necrosis, among the defects reconstructed in this study. The paper does not establish that no flap or graft failures occurred across all six cited papers; its reported outcomes concern its own flap procedures. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe best aesthetic results were achieved when using the revolving door flap or STSG.
“Although all existing reconstructive procedures yield acceptable aesthetic outcomes, the best results were achieved when using the revolving door flap or STSG [1,3,6,7,9,10,12].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The Results report good aesthetic outcomes for the two local-flap techniques studied, and the Discussion describes aesthetic advantages of postauricular flaps while mentioning the revolving-door flap. The paper does not compare aesthetic results across reconstructive procedures or establish that the revolving-door flap or STSG gives the best results. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe aesthetic outcomes of secondary intention healing are inferior to those of the revolving door flap.
“Likewise, its aesthetic outcomes are inferior to those of the revolving door flap [1,3,6,7,9,12].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The Discussion (page not available) says secondary epithelialization can cause scarring and poor aesthetic outcomes, and describes aesthetic advantages of postauricular flaps, including the revolving-door flap. It does not directly compare secondary intention healing with that flap, and its qualified warning does not establish that secondary intention outcomes are generally inferior. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn Zhu (2016), aesthetic results after revolving door flap reconstruction were described as "good" and all patients were said to be satisfied, but the surgeon's opinion was not recorded.
“The aesthetic results in Zhu (2016) were described as “good”, and all patients were said to be satisfied; however, the surgeon’s opinion was not recorded in this study [9].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The Results section describes aesthetic outcomes as good, and the Abstract says all patients were satisfied. But the study reports outcomes for postauricular subcutaneous pedicle island flaps and preauricular translocation flaps, not specifically revolving-door flap reconstruction; the Discussion describes the conventional revolving-door flap as a separate technique. No surgeon-opinion assessment is recorded in the cited passages. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAll existing reconstructive procedures applicable to the auricular concha were explored in this review.
“More importantly, all existing reconstructive procedures applicable to the auricular concha were explored [1,2,3,4,5,6,7,8,9,10,12,18].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The Introduction (page unavailable) mentions flaps and skin grafts, and the Discussion (page unavailable) describes several flap techniques. The paper focuses on two local-flap methods; it does not establish that all existing procedures applicable to the concha were explored, nor present itself as a comprehensive review. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOverall, the risk of bias for the enrolled case series was low following assessment with the JBI Critical Appraisal Checklist for Case Series.
“Overall, the risk of bias for the enrolled case series was low following assessment with the JBI Critical Appraisal Checklist for Case Series [1,4,5,6,7,8,9,10,12,16].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
Controversy remains regarding the preauricular transposition flap because Wines (2001) reported a considerable incidence of flap failure while Zhu (2016) did not identify any cases.
“Controversy remains regarding the preauricular transposition flap, as Wines (2001) reported a considerable incidence of flap failure, but Zhu (2016) did not identify any cases of this complication [2,9].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
Among the five studies examining aesthetic outcome after revolving door flap reconstruction, four used satisfaction scales and one provided only a qualitative description.
“among the five studies examining this outcome after reconstruction with a revolving door flap, Iljin (2018) [7], Iljin (2016) [6], Franco-Muñoz (2020) [1], and Dessy (2010) [3] used satisfaction scales to record the aesthetic outcomes, whereas Zhu (2016) [9] only provided a qualitative description [1,3,6,7,9].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
Aesthetic results were reported in a heterogeneous manner across included studies.
“while complications were presented in the form of incidences in all included studies, aesthetic results were reported in a heterogeneous manner [1,2,3,4,5,6,7,8,9,10,12,18].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
Most included studies had a long follow-up period, ensuring that even long-term complications and aesthetic defects were detected.
“For instance, most included studies had a long follow-up period, ensuring that even long-term complications and aesthetic defects were detected [1,2,3,4,5,6,7,8,9,10,12,18].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The preauricular transposition flap seems acceptable, as no cases of infection, altered scarring, or postoperative hemorrhage were recorded, and it was aesthetically satisfactory.
“Otherwise, this technique seems acceptable, as no cases of infection, altered scarring, or postoperative hemorrhage were recorded, and it was aesthetically satisfactory [2,9].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
This review can provide a global perspective because it comprises studies from several countries conducted by different specialists.
“Moreover, this review can provide a global perspective as it comprises studies from several countries conducted by different specialists (dermatologists, otorhinolaryngologists, or plastic surgeons) [1,2,3,4,5,6,7,8,9,10,12,18].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
For the preauricular transposition flap, Wines (2001) found a 16.7% incidence of flap failure while Zhu (2016) found none; both reported no infections, Wines found no altered scarring or postoperative hemorrhage, and Zhu reported aesthetically satisfactory outcomes.
“While the former found a 16.7% incidence of flap failure, the latter did not identify any cases of such an outcome [2,9]. Furthermore, both studies reported no cases of infection, and Wines (2001) also found no incidence of altered scarring or postoperative hemorrhage [2,9]. According to Zhu (2016), the preauricular transposition flap also yielded aesthetically satisfactory outcomes [9].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The main disadvantage of the revolving door flap is its tendency to produce pinning of the auricle to the scalp.
“its main disadvantage is its tendency to produce pinning of the auricle to the scalp [3,4,5,6,7,8,9].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The Discussion identifies the conventional revolving-door flap but does not describe pinning of the auricle as a disadvantage. It mentions pulling the auricle close to the skull while creating a skin flap, but does not say this is a lasting effect of the revolving-door flap (searched: pinning, pulled close to the skull, revolving-door disadvantage). (LLM, conf=0.73)
Experimental — accuracy not yet measuredSecondary intention healing poses a greater risk of infection compared to the revolving door flap.
“Secondary intention healing poses a greater risk of infection, as compared to the revolving door flap [2,3,4,5,6,7,8,9,12,18].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The Discussion (page not available) associates secondary epithelialization with hypertrophic scarring, not infection. The Results (page not available) list infection as a potential flap complication but report no complications. A search for an infection-risk comparison with the revolving-door flap found none in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredNot all included studies presented data on the two outcomes considered in this review.
“Not all included studies presented data on the two outcomes considered in this review [1,2,3,4,5,6,7,8,9,10,12,18].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [9]
The Results report complications, aesthetic outcomes, and hearing, but do not identify the two outcomes considered in the citing review. This paper does not discuss which studies that review included or whether all of them reported both outcomes; searching for the claim and outcome-reporting terms found no such passage. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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Cites
A simple island flap for reconstruction of concha-helix defects
Masson, J. K. (1972) · British Journal of Plastic Surgery · doi:10.1016/s0007-1226(72)80083-3 · Cited by 137 · see citing works
Dessy, L. A., Figus, A., Fioramonti, P., Mazzocchi, M., & Scuderi, N. (2010) · Journal of Plastic, Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2009.01.073 · Cited by 73 · cited 2× · see citing works
“However, skin grafts may be associated with complications such as delayed wound healing, pigmentation, and centripetal contraction.([3]) Pigmentation is especially obvious in oriental patients.”
BackgroundA New Arterial Flap from the Postauricular Surface: Its Anatomic Basis and Clinical Application
Park, C., Shin, K. S., Kang, H. S., Lee, Y. H., & Lew, J. D. (1988) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-198809000-00023 · Cited by 67 · see citing works
Johnson, T. M., & Fader, D. J. (1997) · Journal of the American Academy of Dermatology · doi:10.1016/s0190-9622(97)70075-6 · Cited by 63 · see citing works
Retroauricular skin: a flaps bank for ear reconstruction
Cordova, A., D’Arpa, S., Pirrello, R., Giambona, C., & Moschella, F. (2007) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2007.09.004 · Cited by 59 · see citing works
Reconstruction of skin cancer defects of the auricle
Reddy, L. V., & Zide, M. F. (2004) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2004.07.006 · Cited by 54 · see citing works
The posterior auricular flap: anatomical studies
Kolhe, P. S., & Leonard, A. G. (1987) · British Journal of Plastic Surgery · doi:10.1016/0007-1226(87)90149-4 · Cited by 45 · see citing works
Auricular reconstruction with a postauricular myocutaneous island flap: Flip-flop flap
Talmi, Y. P., Horowitz, Z., Bedrin, L., & Kronenberg, J. (1996) · Plastic and Reconstructive Surgery · doi:10.1097/00006534-199612000-00010 · Cited by 42 · see citing works
Turan, A., Turkaslan, T., Kul, Z., Isler, C., & Ozsoy, Z. (2006) · Annals of Plastic Surgery · doi:10.1097/01.sap.0000203986.20454.26 · Cited by 37 · see citing works
Anatomy of the Postauricular Island “Revolving Door” Flap (“Flip-Flop” Flap)
Talmi, Y. P., Liokumovitch, P., Wolf, M., Horowitz, Z., Kopolovitch, J., & Kronenberg, J. (1997) · Annals of Plastic Surgery · doi:10.1097/00000637-199712000-00008 · Cited by 35 · see citing works
Reconstruction of the Concha of the Ear Using a Postauricular Island Flap
Chen, C., & Zong-ji, C. (1990) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-199009000-00033 · Cited by 30 · see citing works
Butler, C. E. (2002) · Annals of Plastic Surgery · doi:10.1097/00000637-200209000-00014 · Cited by 29 · see citing works
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The trap door flap: A reliable, reproducible method of anterior pinna reconstruction
McInerney, N. M., Piggott, R. P., & Regan, P. J. (2013) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2013.05.037 · Cited by 15 · see citing works
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Reconstructing a Large Helical Rim Defect
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Flagged first, then by citations
Cited by
Sorted by citations
Kurian, K. E., Oyer, S. L., & Park, S. S. (2025) · Facial Plastic Surgery · doi:10.1055/a-2437-1107 · Cited by 6 · see citing works
Moreno-Vazquez, S., Antoñanzas, J., Oteiza-Rius, I., Redondo, P., & Salido-Vallejo, R. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12206521 · Cited by 6 · see citing works
“…the tragus until it rests over the intertragic notch (previously de-epidermized) and the conchal bowl defect, leaving a pedicle located inferiorly [9]. with some authors claiming secondary intention healing does not in fact cause more pain infection, and poor cosmesis than the alternative…”
BackgroundMethodResultInfluential
- Authors
- Zhu, J., Zhao, H., Wu, K., Lv, C., Bi, H.-D., Sun, M.-Y., Wang, Y.-C., Xing, X., & Xue, C.-Y.
- Affiliations
- Second Military Medical University (CN)
- Venue
- Medicine
- Published
- 2016-11
- Volume
- 95
- Issue
- 46
- Pages
- e5282
- ISSN
- 0025-7974 (ISSN-L)
- PMC
- PMC5120910
- OpenAlex
- W2556219636
- Cited by
- 20
- References
- 18
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 4
- FWCI
- 1.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Health Sciences › Medicine › Surgery › Reconstructive Surgery and Microvascular Techniques
- Health Sciences › Medicine › Surgery › Head and Neck Surgical Oncology
- Keywords
- local flaps, ear reconstruction
- MeSH terms
- Adult, Ear Neoplasms, Ear, External, Female, Humans, Male, Middle Aged, Surgical Flaps, Wound Healing, Treatment Outcome, Plastic Surgery Procedures
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