Borderline indications for ear reconstruction.

While the indication for an ear reconstruction with rib cartilage is clear in pediatric patients and patients without previous surgery, there are borderline cases in which neither a reconstruction nor a prosthesis seems to be first choice. Within the last 6 years, approximately 120 patients were treated with a reconstruction with rib cartilage and 20 with a prosthesis at our hospital. Patients without extensively scarred periauricular tissue clearly benefit by a reconstruction with cartilage. The classic indication for an ear prosthesis is status post-malignant tumor resection. In borderline cases presenting with heavy scars, the most favorable repair method has to be decided upon individually. Under these circumstances, one of the main criteria for a reconstruction with rib cartilage is a viable temporoparietal fascia flap. A consideration that is important to note is that an unfavorable ear reconstruction can be converted almost always into a prosthesis repair but very rarely vice versa.