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Many methods of earlobe reconstruction using one or two stages have been described. These have used (i) the superimposition of two flaps, (ii) a single flap lined with a skin graft or (iii) doubled-over single or bilobed flaps. We present a new method of earlobe reconstruction using a doubled-over Limberg flap, which we have used in six ears. This produces a good-looking earlobe, which needs defatting after 3–4 months and suffered minimal necrosis at the tip of the folded flap in three cases. There was no earlobe shrinkage on long-term follow-up.
Earlobe loss may be congenital or, more commonly, acquired as the result of trauma or burns. Methods of earlobe reconstruction may be classified as follows: (i) superimposition of two opposing or paired flaps;
Many techniques are single-stage procedures, but where a connection between the ear stump and the mastoid skin is required, the procedure is two staged. In the first stage the inferior edge of the ear is sutured to the mastoid skin, and in the second stage the flap is elevated for reconstruction.
We present a new method of earlobe reconstruction using a doubled-over Limberg
Before undertaking any of the sophisticated techniques, it is advisable to assess the residual local tissues carefully and to consider the use of a simple repair
was performed in six ears. In one case the earlobe was congenitally absent, in four ears the loss was the result of trauma and in one it was the result of burns. All the patients were females aged between 18 and 35 years.
1.1 Operative technique
The opposite normal earlobe was used as a model for the earlobe being reconstructed. The operation was performed under local anaesthesia using 1% lignocaine hydrochloride.
The earlobe defect is roughly a sector of a circle (abd) (Fig. 1) , which would become a rhomboid (abcd) if its posterior—medial layer were unfolded. A Limberg flap
(ad'ef) is marked, incised and raised anteroinferior to the earlobe defect. The donor area is closed after undermining the edges (Fig. 2) . The inferior edge of the ear (ab) is incised, the Limberg flap is transposed and the edge ad' is sutured to the edge ab of the ear in two layers (Fig. 2). The flap is folded along its short diagonal (d'f) so that the distal half (d'ef) (shaded in Fig. 2) comes to lie behind ad'f and point e comes to lie behind point a (Fig. 3) . The edge d'e is stitched to the posterior edge of ab, and edge ef is stitched to af (Fig. 3).
Figure 1The earlobe defect (abd) and its unfolded posterior—medial layer (bdc). Also shown is the Limberg flap (ad'ef).
Figure 2The donor defect has been closed and the Limberg flap transposed. The edge ad' is sutured to the auricular edge ab. The shaded portion of the flap (d'ef) will form the medial—posterior layer.
The Limberg-flap technique produced a good-looking earlobe in all cases (Figure 4, Figure 5) , though it was a little bulky and needed defatting after 3–4 months. There was minimal necrosis at the tip (point e, Fig. 3) of the folded portion of the flap in three cases, but, being hidden, this did not affect the end result, and healing occurred within 10–15 days. The donor defect is visible and needs careful suturing to give a fine scar. The attachment of the reconstructed earlobe to the cheek is a little more anterior than normal. We did not face any specific problems in patients who had lost an earlobe as the result of trauma or burns, as the reconstruction was done when healing was complete (3–4 months after trauma or burn).
Figure 4(A) Preoperative view of a patient who had suffered the traumatic loss of an earlobe. (B) The Limberg flap and the inferior edge of the ear have been incised. (C) The donor defect has been closed. The Limberg flap is transposed and ready to be sutured to the incised edge of the ear. The coloured distal portion of the flap will be folded behind the unshaded proximal portion. (D) Immediate postoperative result.
Figure 4(A) Preoperative view of a patient who had suffered the traumatic loss of an earlobe. (B) The Limberg flap and the inferior edge of the ear have been incised. (C) The donor defect has been closed. The Limberg flap is transposed and ready to be sutured to the incised edge of the ear. The coloured distal portion of the flap will be folded behind the unshaded proximal portion. (D) Immediate postoperative result.
using two opposing flaps or a single or bilobed doubled-over flap. This method is not suitable if the loss is greater than an earlobe. In such cases other methods
can be used. At 1–2 years follow-up we did not observe any shrinkage of the earlobe and hence do not consider it necessary to use cartilage to maintain earlobe shape and size. Implantation of cartilage in the earlobe may create contour and support but will take away its natural soft feel. Any tendency of the earlobe to shrink over time can be compensated by initial overcorrection.
The Planning of Local Plastic Operations on the Body Surface: Theory and Practice. Government Publishing House for Medical Literature,
1963 (English Translation: Wolfe SA. Lexington, MA: DC Heath & Co, 1984)
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