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This is a small defect down to perichondrium on the patient's ear.  However, the entire posterior surface of the superior portion of the auricle had undergone a split thickness skin graft reconstruction 2 years previously.

The skin graft started to die.

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The entire graft was lost.

However, the entire posterior surface, underneath the skin graft was also lost.  This was in the area of the original skin graft placed two years ago.  Now the defect was through and through.

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1st Stage Surgery:
A scalp flap was now used to close the defect.

1st Stage Surgery
 

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2nd Stage Surgery:
this stage was performed 6 weeks after the first stage, because of the ear's poor blood supply in this patient.  A scalp flap for the posterior surface was fashioned.

2nd Stage Surgery
The scalp flap was then sewn into position.

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