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Bilateral advancement flaps with helical rim Z-plasty modification for management of ear defects.

External ear cutaneous malignancies comprise approximately 6% of all head and neck skin cancers, the standard therapy for which includes surgical excision with histologic margin control, as exemplified by Mohs micrographic surgery (MMS). Major deformity after successful ablation of ear lesions remains a major concern. Wound management techniques that have been described include primary closure, wedge resection, local flaps, chondrocutaneous grafts, various staged procedures, and healing by second intention. Ultimately, the reconstruction approach depends on the wound size and site, cartilage integrity, and whether the structural loss is partial, full thickness, or segmental. In the course of ear reconstruction, the bilateral helical rim advancement flap is often chosen due to its ability to restore ear curvature. We have found that the helical rim incision line frequently creates some notching during scar maturation. In an effort to ameliorate or even avert this cosmetic issue, we advocate a helical rim Z-plasty modification, which serves to break up the incision line and redistributes tension vectors, leading to a better cosmetic outcome.