Reconstruction of posterior auricular ear surface defects: “Ear Keystone graft”

Malignant cutaneous tumors are common on the external ear1 and reconstruction of posterior auricular surface's defects after surgical removal of cancer can be performed using different strategies. These techniques can be not easy or not really quick to perform, therefore we believe that it can be useful to propose another strategy to evaluate between the different reconstructive options in this anatomical region. The Keystone Design Perforator Island Flap (KDPIF), a curvilinear shaped trapezoidal design flap described by Felix C Behan in 2003,2 is a solution to reconstruct soft tissue defects in head and neck, trunk, and extremities. Based on fasciocutaneous perforators, this flap offers both the robust vascularity of perforator flaps and the relative ease and speed of local tissue rearrangement. In this regard we present our experience with the use of the KDPIF for the posterior surface of the auricle's reconstruction after removal of a skin epithelioma. This application of KDPIF has never been described in literature and it is a special feature due to the lack of perforating vessels that supply blood to the flap in this anatomical region.