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ative bleeding, occurring in two patients (5.55%), resolved with adequate pressure dressings; other complications (flap necrosis, infection, and auricular deformities) did not occur. The mean postoperative follow-up time was 4 weeks. The vascular supply of the auricle by superficial temporal artery, posterior auricular artery, and multiple anastomoses allows a very good blood supply facilitating the preparation of auricular flaps. Helical, antihelical, and earlobe tumors can be resected by wedge excision. Chondrocutaneous flaps can also reconstruct multilayered defects of the auricle; however, these reconstructions often lead to vertical auricular shortening and bilateral asymmetry. Pedicled flaps with/without cartilage harvesting for reconstruction of large helical, antihelical, and retroauricular defects are also described; these, however, represent multi-step procedures with higher risks of periand postoperative complications. Full-thickness skin grafts at the auricular level also bare a risk of graft contraction and subsequent auricular deformity. Split-thickness skin grafts (STSGs) are a good alternative for auricular defects with cartilage preservation (especially in the antihelix area), avoiding potential pincushioning after flap reconstruction or postoperative contractions; a disadvantage is the secondary defect induced by STSG; nevertheless, harvesting the STSG in the hair-bearing retroauricular area seems to lead to a fast healing and very good esthetic outcome. TFs can be used for reconstruction of a high variety of anterior and posterior auricular defects, providing several advantages: little trauma, simple single-step procedure, minimal scarring, high flap survival rate, great color and texture match, and avoidance of auricular deformation. Furthermore, they require less undermining compared to other flaps while reorienting tension vectors to favorable directions. Even in cases where the underlying cartilage has been partly resected, such as smaller conchal defects, antihelix, or crus helix defects, TFs represent a good option without compromising the auricular shape. However, in cases of large defects with significant cartilage loss, alternative or complementary reconstruction techniques including cartilage harvesting (e.g., rib, contralateral concha) are required in order to not disrupt the auricular shape, firmness, and framework given by the cartilaginous structure. We consider TFs as suitable alternatives for auricular reconstruction of various anatomical subunits without significant cartilage loss, leaving almost unnoticeable donor-site scars, often concealed in hairy areas or the junction of esthetical subunits. TFs are single-step procedures for reconstructing a big variety of defects, leading to good esthetic outcomes, with minimal risk of postoperative complications. In cases of significant cartilage loss, TFs can be combined with cartilage harvesting procedures in order to maintain the three-dimensional auricular structure. Diana Crisan *, MD Elisabeth Lormes , MD Karin Scharffetter-Kochanek , MD Lars A. Schneider , MD Department of Dermatology and Allergic Diseases, University Medical Center Ulm, Ulm, Germany, and Department of Dermatology and Dermatosurgery, Helios Clinic, Rottweil, Germany *E-mail: diana.crisan@uniklinik-ulm.de