Case 3: Ear

Authors: Eirini Tsigka, MD, MSc, Christian Kaare Paaskesen Med. Stud. and Magnus Avnstorp, MD.

Patient History

92-years old man, with biopsy verified SCC 12x6mm in the left antihelix of ear. There was indication for excision of tumor in a 0.5cm margin to cartilage level with afterwards reconstruction using a full-thickness skin graft.

Surgical considerations

The cartilaginous windows and perichondrium of the ear provides excellent vascularity for successful skin grafting.
Full thickness is preferred to cover the exposed cartilage of the ear

Technique by steps

Step 1: Tumor is marked

Tumor is marked in 5 mm margin.

Step 2: Defect after tumor excision

Defect after tumor excision, perichondrium is preserved for better vascularity possibilities. Take note windows made through cartilage, to increase ingrowth of blood vessels to nourish skin graft.

Step 3: Graft is secured to recipient site

Full skin graft is secured to recipient site with running 5-0 nylon. Take note of the meshing.

Step 4: Bolster is secured

Afterwards a bolster is secured with 4-0 running suture, “Blanket stitch”. Note that suturing in concha can be tricky and eventually more layers of bolster are needed, to secure better compression of the graft. Dressing in the ear consist of both Nitrofurantoin and Vaseline mesh gauze.

Step 5: Donor site

Supraclavicular donor site.