Propeller flaps in partial ear reconstruction: a case series

Background: Ear defect reconstruction still remains a surgical challenge today. Proper reconstruction should result in correction of the deformity with minimum morbidity with the aim of achieving the most esthetically pleasing outcome possible. Herein, we present our clinical experience with propeller flap reconstruction of external ear defects with a focus on indications and surgical technique. Methods: Fourteen patients underwent surgery at our Plastic Surgery Unit between January 2015 and October 2019. After identifying perforators with a handheld Doppler ultrasound, a tailor-made flap was designed for each patient. Following tumor excision, dissection of the pedicle and of the remaining flap was performed with the aid of surgical loops. Flap in-setting and donor site closure were final steps. Results: Flaps have survived in their entirety in almost all our patients (13/14) maintaining optimal color and elasticity and showing no complications. In one case, a superficial distal necrosis was observed and, in another patient, tumor recurrence took place. Conclusions: Propeller flaps offer great advantages when used in ear reconstruction ensuring excellent esthetic results with a one-stage technique. Nevertheless, it must be kept in mind that good dissection skills are required in order to avoid complications. Level of evidence: Level IV, Therapeutic study.