Interpolation flap for closing a surgical defect in the ear lobe

Received on: 26 January 2012
Approved on: 19 February 2012
This study was carried out at the
Dermatology Department of the Hospital
Universitário do Norte do Paraná da
Universidade Estadual de Londrina (UEL) –
Londrina (PR), Brazil.
Financial support: None
Conflict of interest: None

Abstract

An interpolation flap is an effective method for reconstructing large and deep defects when the surrounding tissue does not allow direct closure. These flaps use tissue from non-adjacent areas with a vascular pedicle that supplies the flap until neovascularization between the flap and the recipient area occurs. This study describes the use of an interpolation flap to close a defect in the anterior ear lobe that resulted from the excision of two basal cell carcinomas.

Keywords: SURGICAL FLAPS, EAR, CARCINOMA, BASAL CELL

INTRODUCTION

Basal cell carcinomas (BCC) are the most common type of cutaneous tumors, accounting for approximately 70% of all skin cancers. Although surgical excision is normally recommended, there may be situations in which direct closure is not feasible, requiring the use of a flap or a graft. 1

An interpolation flap consists of a segment of skin and subcutaneous tissue that rotates on a pivot, extending in the shape of an arc up until a defect located nearby, however not immediately adjacent. That flap''''''''s pedicle passes over the normal skin, under which the surgeon carries out the repair. 2-5

This case report describes the use of an interpolation flap to correct a wound secondary to the exeresis of two BCCs located in the earlobe.

CASE REPORT

J.C., a 70-year-old male patient, presented with two lesions in the anterior lobe of the left ear, compatible with superficial BCC (Figure 1). After marking the lesions with 0.5 cm margins, the tumor was excised. Primary closure of the raw area was not possible (Figure 2). An interpolation flap was chosen to close the raw area (Figure 3). The flap was positioned and sutured in the site with mononylon 6.0, leaving out a small vascular pedicle; this area was closed with mononylon 5.0 sutures (Figure 4). The stitches were removed one week later (Figure 5). The resection of the pedicle was carried out three weeks later (Figure 6). The patient recovered without complications and with a good aesthetic result.

DISCUSSION

Cutaneous flaps are a necessary technique for closing excisions of skin tumors. 1-5 In dermatologic surgery, most flaps use skin adjacent to the wound, which leads to better aesthetic results. 2

Extensive wounds resulting from surgical excisions of cutaneous neoplasias in the earlobe pose a considerable surgical challenge. Therefore, it is essential to choose the appropriate technique in order to obtain the best aesthetic results. 5

This case used the interpolation technique, which is an excellent method for closing large and deep defects if the surrounding tissue does not allow direct closure. Tissues from nonadjacent areas are used in those cases, leaving out a vascular pedicle to supply the flap until neovascularization is established between the flap and the recipient site. The main disadvantage of this type of flap is that it requires two surgeries to complete. The resection of the pedicle is carried out after the complete neovascularization of the recipient area, which usually occurs after three weeks. 2-5

This case report describes the successful use of the interpolation flap technique, which led to satisfactory, aesthetically acceptable results without complications.

References

1 . Amaral ACN, Azulay DR, Azulay RD. Neoplasias malignas da epiderme e anexos. In: Azulay RD, Azulay DR, Azulay-Abulafia L. Dermatologia. 5. ed. Rio de Janeiro: Guanabara Koogan; 2011.p.605.

2 . Mellette JR, Ho DQ. Interpolation Flap. Dermatol Clin.2005; 23(1):87-112.

3 . Barlow RJ,Swanson NA.The nasofacial interpolated flap in reconstruction of the nasal ala. J Am Acad Dermatol. 1997;36(6): 965-9.

4 . Johnson MT, Fader DJ. The staged retroauricular to auricular direct pedicle (interpolation) flap for helical ear reconstruction. J Am Acad Dermatol. 1997;3796):975-8.

5 . Di Mascio D, Castagnetti F.Tubed flap interpolation in reconstruction of helical and ear lobe defects. Dermatol Surg 2004; 30(4): 572-8.