Costal Cartilage or Conchal Cartilage for Aesthetic and Structural Reconstruction of Lower Pole Ear Defects

Background: Lower pole defects of the ear involve loss of the ear lobule with a variable degree of cartilaginous helical rim and antihelix. Objectives: The authors describe a method of reconstructing lower pole ear defects with local skin flaps by incorporating conchal or costal cartilage grafts. Methods: The authors retrospectively evaluated the charts of 13 patients who presented between 1998 and 2007 with lower pole auricular defects. For defects primarily involving the earlobe (seven cases), conchal cartilage was sandwiched between an anterior transposition flap and a posterior V-Y advancement flap. For defects extending into the inferior portions of the helical rim and antihelix (six cases), a costal cartilage framework was inserted into a skin pocket and released after six months. Results: The mean follow-up for the 13 patients in this series was three years. Both techniques resulted in satisfactory long-term outcomes with excellent contour of the ear. All patients were satisfied with their reconstruction. Data showed that costal cartilage reconstructions required a minimum of two stages and that construction with conchal cartilage resulted in a softer lobule but was more likely to require minor aesthetic revision. Conclusions: With appropriate preoperative planning, these cartilage graft techniques produce excellent aesthetic outcomes in reconstructing complicated defects of the lower pole of the ear.