Closing surgical defects of the external ear poses unique challenges because of the convoluted shape and thin tethered skin. Choice of repair is often dictated by the site of the wound. If the defect is central and anterior with intact cartilage, most defects will do well by second intention healing or grafting. If the defect involves the helical rim, reconstruction is often preferred to maintain the normal curvature of the external ear and a helical rim advancement flap with trimming of the central cartilage is often used. Defects of the posterior ear where the skin is more abundant and loose can often be closed side to side. Split earlobes may be repaired by Z-plasty. The full range of repair options should be considered in every case. Because each ear differs in shape and flexibility, creativity is warranted, rewarding both the patient and the surgeon.
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