Inferiorly Based Postauricular Periosteofascial Flap for Reconstruction of Intractable Small Postauricular Defects

BACKGROUND: Small postauricular defects are a common problem after treatment of chronic otitis media and after excision surgery for small skin cancers. Blood supply to the postauricular area is poor, and bone exposure is common. Grafts involving alloplastic materials, cartilage, and bone often yield unsatisfactory results. A standard surgical procedure for successfully treating such defects has yet to be established. The present study examined the use of postauricular fascial free flaps for the reconstruction of small intractable postauricular defects. METHODS: From August 2006 to August 2007, 3 patients (2 with chronic otitis media and 1 patient with squamous cell carcinoma) with postauricular defects underwent mastoid flap surgery. The inferiorly based postauricular fascial flap included the periosteum and the sternocleidomastoid muscle. The flaps measured 2 to 4 x 2.0 to 3.5 cm, and the mean follow-up period was 11.5 months. RESULTS: There were no serious complications, such as fistula recurrence, infection, or flap necrosis during the follow-up period. CONCLUSIONS: Current methods for repairing small postauricular defects often fail. Although free flap surgery is generally considered inappropriate for such defects, the postauricular flap method applied here appeared to be successful.