Bilobed Flap
Full Thickness Skin Graft to Ear, Skin Cancer, Kevin Kavanagh



  • Slide 1. Preoperative AppearanceA large squamous cell carcinoma involving the auricle.
  • Slide 2. Skin and Cartilage IncisionThe lesion is excised including underlying cartilage.
  • Slide 3. Elevation of CartilageThe cartilage is elevated off the perichondrium using a freer elevator.
  • Slide 4. Removal of LesionThe dissection is continued until the lesion and underlying cartilage is removed.
  • Slide 5. Operative DefectAnother two millimeters of cartilage is removed under the skin. The anterior and posterior portions of the antihelix are closed upon itself using 5-0 nylon stitches. The donor site is outlined behind the ear.
  • Slide 6. Placement of Full-Thickness Skin GraftA full-thickness skin graft is elevated using a #15 BP blade. It is sewn in place using 5-0 Nylon stitches.
  • Slide 7. Sewing Skin Graft in PlaceLong bolster stitches are placed at intervals along the perimeter of the graft. Between the bolster stitches, stay stitches are placed to secure the graft.
  • Slide 8. Bolster StitchesHemostats are used to keep the bolster stitches from becoming entangled.
  • Slide 9. Pie Crusting the Full Thickness-Skin GraftA #11 BP blade is used to perforate the graft at multiple areas to prevent blood from forming under the graft. If this were to happen, the graft would float off the recipient bed.
  • Slide 10. Sewing Bolster in PlaceA bolster composed of cotton and Adaptic is secured over the graft using the bolster stitches.
  • Slide 11. Immediate Post-Operative AppearanceFinal appearance of the bolster. The donor site was reexcised and surrounding skin undermined. The donor site was closed with a 3-0 chromic stitch for underlying subcutaneous tissue and a 3-0 nylon stitch for skin.
  • Slide 12. Immediate Post-Operative AppearanceAppearance of the skin graft at 8 days post-op., after the bolster has been removed. There is almost 100% take of the skin graft.
  • Slide 13. Post Operative AppearanceAppearance of the skin graft at 7 weeks after the operation.
Ear Surgery - Resection of a Squamous Cell Carcinoma of the Auricle
And Reconstruction with a Full-Thickness Skin Graft 



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