2018 AMI Online Salon

Three Stage Surgery to Repair Conchal Bowl Defect

Project Details

  • Artist(s):  Jill Gregory; New York, New York
  • Client: Dr Mark Urken
  • Copyright: © 2017 Mount Sinai Health System
  • Medium / software used: Adobe Photoshop
  • Final presentation format: American Journal of Otolaryngology
  • Primary audience: ANT Surgeons

Project Description

This figure describes a 3-stage surgery to repair an auricular defect, secondary to Mohs excision of a squamous cell carcinoma of the conchal bowl (CB). A focus throughout the illustration is the maintenance and protection of blood supply to the flap. In stage 1 (A-F) a post-auricular flap supplied by the PAA (posterior auricular artery) is raised and folded in half, to recreate the anterior and posterior skin of the CB. The flap is rotated so that the folded edge of the flap is superior. The lateral edges are sutured; posterior and inferior edges are left free, to protect the blood supply (folded PAA seen ghosted in the flap). In stage 2 (G-H), the superior and inferior edges are de-epithelialized and sutured. In stage 3 (I-K), the flap is debulked, and temporarily supported with a bolster. Post-auricular skin is advanced to fully close the flap harvest wound. A combination of surgical and cross-section views help the reader comprehend the orientation of the flap and the PAA.