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Page 6 of 8 Rosi-Schumacher et al. Plast Aesthet Res 2022;9:11 https://dx.doi.org/10.20517/2347-9264.2021.64

[22]
skin are elevated together to form the new lobule while the donor site is closed primarily . If needed, skin
grafts may be used for further coverage.

[35]
Another one-stage reconstructive option for earlobe defects is Gavello’s procedure . This technique uses
the postauricular mastoid region as the flap donor site, which receives its arterial supply from the occipital
branch of the posterior auricular artery . A bilobed skin flap is created in the postauricular skin. First, a
[35]
straight incision is made at the level of the earlobe defect and extended to twice its length. Next, a curved
incision is made in the arc shape of an earlobe, beginning one centimeter inferior to the straight incision. A
second curved incision is made in continuity with the first and connects the distal aspect of the straight
postauricular incision. The bilobed flap is then raised by subcutaneous dissection and folded on itself at the
middle point between the two curved incisions. The superior aspect of the flap is then sutured to the cut and
freshened margin of the earlobe defect. The lower curved borders of the bilobed flap are sutured and form
the margins of the newly reconstructed earlobe. The postauricular donor site can be closed primarily after
wide undermining.

COMPLICATIONS
Complications of auricular reconstruction may include hematoma, infection, hypertrophic scarring, and
poor healing. Surgeons should be careful to obtain meticulous hemostasis during all phases of the operation.
The proper post-operative dressings with the use of delicate compression over the reconstructed ear may
also aid in skin flap adherence. The surgeon should monitor for skin necrosis that may occur up to two
weeks after surgery. It should be treated by removal of the dead tissue and subsequent coverage of the
exposed cartilage with a fascial flap followed by skin graft, or other reconstructive options. Costal cartilage
harvest for auricular reconstruction carries its own unique complications. Accidental penetration of the
lung pleura during surgical dissection of the rib can cause a pneumothorax and should be treated
accordingly with chest tube insertion. Long-term complications of auricular reconstruction may also occur,
including absorption of cartilage and loss of auricular support. This is often the result of high-tension
surgical closures and may require a secondary reconstructive operation.

CONCLUSIONS
The unique structure of the auricle with a complex cartilaginous framework poses an intricate challenge to
the reconstructive surgeon. The ear’s functions, including support of glasses and hearing aids as well as its
important aesthetic relationships to the face, call for careful attention to detail when designing its
reconstruction. The goals of restoring both form and function as well as achieving facial symmetry and
balance are made possible through a systematic approach to reconstructive surgery. Understanding
principles and techniques as well as staged methods of reconstruction will be essential to achieve these
endpoints.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the study, performed final editing of the
document for publication: Rosi-Schumacher M, Shokri T
Provided administrative and technical support, contributed to the final editing of the document for
publication: Bassichis B

Availability of data and materials
Not applicable.