Wound Healing Strategies for Auricular Defects With Exposed Cartilage: A Literature Review

Auricular defects with exposed cartilage require durable wound coverage while preserving the framework that determines ear contour. Management becomes particularly challenging when exposure follows autologous microtia reconstruction, because loss of soft-tissue coverage can compromise a surgically constructed cartilage framework. This narrative review examines treatment strategies across native auricular wounds and exposed autologous frameworks. Targeted web-based searches identified primary anatomical and clinical studies, which were synthesized according to wound-bed requirements, reconstructive purpose, and reported outcomes. Secondary intention can achieve healing in selected native auricular defects, including some with exposed cartilage. Skin grafts are established coverage options when a vascularized recipient bed is available, but outcomes from general auricular graft series cannot be assumed to represent completely denuded cartilage. Local flaps provide vascularized coverage, while temporoparietal, posterior auricular, and mastoid fascial flaps are important options for threatened reconstructed frameworks. Small clinical series also describe acellular dermal matrices and negative-pressure wound therapy, although their comparative effectiveness remains uncertain. Post-Mohs wounds, traumatic composite defects, and exposed microtia frameworks represent different clinical problems and should not share an undifferentiated treatment algorithm. Selection should integrate cartilage viability, perichondrial status, wound location and extent, infection, available donor tissue, and structural requirements. Current evidence favors context-specific reconstruction rather than a universally preferred technique. Future studies should distinguish native cartilage from grafted frameworks and assess lasting contour and framework preservation alongside epithelial closure.