Reconstruction of the Auricular Antihelix Using a Preauricular Transposition Flap

Reconstruction of antihelical defects in the auricle is technically challenging because of the auricle’s complex 3-dimensional anatomy, limited adjacent tissue, and frequent cartilage involvement. We describe a single-stage reconstructive technique using a superiorly based preauricular transposition flap for repair of an antihelical defect. An 80-year-old man underwent radical excision of Merkel cell carcinoma of the antihelix with a 5-mm safety margin, resulting in an 18-mm full-thickness defect involving skin and cartilage. Reconstruction was performed by elevating a superiorly based preauricular flap, de-epithelializing the bridging segment, and transposing the flap through a tunnel beneath the helical crus for inset into the defect, with primary closure of both donor and recipient sites. The postoperative course was uneventful, with no flap congestion, infection, or necrosis. At 6 months of follow-up, the reconstructed auricle demonstrated good anatomic contour without deformity and minimal donor-site morbidity. The superiorly based preauricular transposition flap is a reliable and effective single-stage option for reconstruction of antihelical defects, providing excellent color and texture match, preservation of auricular contour, and favorable aesthetic outcomes.