Fifty free flaps from the ear

Summary Background Reconstruction of facial and intraoral defects is often challenging. Local pedicled flaps may not always be available and distant free flaps usually have suboptimal color match and texture for the facial area. The aim of this study is to assess whether auricular free flaps are a valid reconstructive option. Methods Clinical data and outcomes of patients who underwent reconstruction with microsurgical flaps from the ear between 2011 and 2021 were analyzed. Patient demographic data, type of flaps, etiology, location and size of the defect, features of the pedicle and recipient vessels, complications and additional surgeries were reviewed. Results Overall, 48 patients with 50 microsurgical flaps were identified. Thirty-one patients (65%) were male and 17 (35%) female. The median age was 62 years. Among the 50 flaps, 26 (52%) were helix flaps, 20 (40%) were TAPAS flaps and 4 (8%) were extended helix flaps. The nose was the most frequently reconstructed region (n=32, 64%), followed by the tongue (n=6, 12%), floor of the mouth (n= 5%), lower eyelid (n= 2%), and in one (2%) patient each, restoration of the upper eyelid, ear, larynx, esophagus, lower lip and palate. The median follow-up was 74 months. Three flaps (6%) were lost, while the overall rate of complications was 46%. Surgical intervention was required in seven (14%) cases. All cases healed with acceptable cosmesis. Conclusions The ear is a valuable source of tissue for complex reconstructions of the face and intraoral region. However, this technique is surgically demanding and should be reserved for selected cases.