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- Presentation
Case-Based Reconstruction Options for Ear, Temple, and Medial Canthus Defects
Description
The speaker presents three case-based reconstruction discussions focused on the ear, temple, and medial canthus. For a small mid-earlobe post-Mohs defect, options included grafting, wedge excision, primary closure, and various local flaps; the speaker favored a preauricular transposition/interpolated flap in selected cases, but also emphasized that a wedge or primary closure may be appropriate when laxity is adequate and cosmetic expectations are lower. For a temple defect, they highlighted the importance of accounting for temporal branch facial nerve weakness and the likely need to elevate the brow at the same time; rather than staging the repair, they recommend incorporating a crescent excision/standing cone above the eyebrow into the reconstruction, often using a rhombic-type flap from below, especially when deep resection is anticipated. The most complex case involved an elderly woman with a medial canthus defect extending into the lower lid and lacrimal drainage system. The discussion stressed that repair requires restoring both eyelid lamellae and the lacrimal apparatus, often with a multidisciplinary oculoplastics approach. Proposed methods included cheek rotation, cartilage grafting, forehead flap reconstruction, and delayed or specialized stenting, with the final management involving oculoplastics advancing the upper lid and grafting the inferior medial lid, while the reconstructive surgeon coordinated subsequent forehead flap takedown and contouring.
View moreConclusions
- For a small central earlobe post-Mohs defect, primary closure or a simple wedge-type repair is often adequate when laxity is available, while preauricular interpolation is reserved for cases needing better symmetry or higher cosmetic precision.
- Mid-earlobe reconstruction can even use adjacent tissue creatively, such as incorporating a nearby nevus into antitragus reconstruction, to achieve a fast and elegant contour.
- For temple defects, the key conclusion is that one-stage reconstruction with a rhombic or crescent-based design can be preferable when the surgeon anticipates the need for brow elevation, because it avoids a second operation.
- Standing cones around temple repairs should be addressed at the initial operation when possible, since doing so helps preserve brow position and visual field without requiring staged revision.
- Persistent temporal branch palsy may be managed more efficiently by integrating brow-lift correction into the reconstruction plan rather than waiting for a separate second-stage procedure.
- Large or complex medial infraorbital cheek, eyelid, and nose defects often require subunit-based reconstruction, cartilage support, and coordination with oculoplastics to restore both form and lacrimal function.
- When the lacrimal drainage apparatus is destroyed, cosmetic closure alone is insufficient and reconstruction of the tear drainage system becomes a major priority.
- Even in very elderly patients, aggressive reconstruction can still be appropriate if overall health, laxity, and functional goals support it, but these cases often benefit from multidisciplinary planning.
- Across these cases, the presenter’s overall message is that reconstruction should be tailored to defect size, tissue laxity, functional risk, and aesthetic priorities rather than using a single default technique.
- The presentation concludes that many post-Mohs defects can be repaired successfully in one operative setting if the reconstruction is planned around expected contour changes, functional needs, and likely revisions.
- IK Procedural Dermatology
- Iren Kossintseva, MD FRCPC FAAD FACMS
- Irèn Kossintseva, MD FRCPC FAAD FACMS
- The University of British Columbia
- University of British Columbia (UBC)
- AAD 2026