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A large squamous cell carcinoma involving the auricle.
The lesion is excised including underlying cartilage.
The cartilage is elevated off the perichondrium using a freer elevator. 
The dissection is continued until the lesion and underlying cartilage is removed.
Another two millimeters of cartilage is removed under the skin. The anterior and posterior portions of the antihelix are closed upon itself using 5-0 nylon stitches.
The donor site is outlined behind the ear.
A full-thickness skin graft is elevated using a #15 BP blade. It is sewn in place using 5-0 Nylon stitches.
Long bolster stitches are placed at intervals along the perimeter of the graft. Between the bolster stitches, stay stitches are placed to secure the graft.
Hemostats are used to keep the bolster stitches from becoming entangled.
A #11 BP blade is used to perforate the graft at multiple areas to prevent blood from forming under the graft. If this were to happen, the graft would float off the recipient bed.
A bolster composed of cotton and Adaptic is secured over the graft using the bolster stitches. 
Final appearance of the bolster. The donor site was reexcised and surrounding skin undermined. The donor site was closed with a 3-0 chromic stitch for underlying subcutaneous tissue and a 3-0 nylon stitch for skin.
Appearance of the skin graft at 8 days post-op., after the bolster has been removed. There is almost 100% take of the skin graft. 
Appearance of the skin graft at 7 weeks after the operation.
