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A case describes an 88-year-old patient with a partial-thickness defect exceeding one-third of the right helical rim after Mohs surgery. Reconstruction used a double transposition flap from surrounding skin, without cartilage grafting. Both flaps survived without complications, and outcomes were satisfactory with good cosmetic results.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/a-novel-surgical-approach-double-transposition-flap-for-reconstruction-of-a-large-partial-thickness-defect-of-the-helical-rim/442849/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/a-novel-surgical-approach-double-transposition-flap-for-reconstruction-of-a-large-partial-thickness-defect-of-the-helical-rim/442849.png","ImageObject",300,407,{"name":92,"@type":93},"mieayamfan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is reconstruction of helical rim defects difficult after tumor removal?","Question",{"text":112,"@type":113},"The ear’s unique anatomy makes it hard to restore the natural curvature, and large helical rim defects after skin tumor excision require careful surgical planning to avoid distortion and complications.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What surgical technique was used to reconstruct the reported defect?",{"text":117,"@type":113},"The defect was reconstructed using a double transposition flap harvested from the surrounding skin, with one flap covering the upper half and the other covering the lower half of the defect.",{"name":119,"@type":110,"acceptedAnswer":120},"Was a cartilage graft needed in this case, and what were the outcomes?",{"text":121,"@type":113},"No cartilage graft was needed because the patient’s cartilage was not damaged during surgery. Both flaps survived without complications, and immediate and long-term outcomes were satisfactory with good cosmetic results.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},442849,1791162386,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},962090893677,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Ideas and InnovatIons  \nReconstructive  \nA Novel Surgical Approach for the Reconstruction of a Large Partial-Thickness Defect of the Helical Rim  \nVerónica Ruiz-Salas, MD, PhD  \nSummary: The unique anatomy of the ear makes it difficult to reconstruct. In terms of restoring the natural curvature of this anatomic site, repair of large defects involving the helical rim after skin tumor removal presents a unique surgical challenge. We present a case ofa patient with a partial-thickness surgical defect involving more than one-third of his right helical rim. The defect was reconstructed using a double transposition flap, with the flap taken from the surrounding skin. There was no need to interpose a cartilage graft, as there was no damage to the patient’s own cartilage during the surgery. Both flaps survived with no complications. This single-staged surgical technique was performed under local anesthesia. The immediate and longterm outcomes were satisfactory, and cosmetic results were good. We describe the double transposition flap as an innovative technique for reconstructing specific ear defects. In particular, it is an excellent surgical option for the reconstruction of large surgical defects involving the helical rim. For defects such as the one outlined here, this flap may be considered as an alternative reconstructive option, provided the patient’s medical condition allows. (Plast Reconstr Surg Glob Open 2026;14:e7337; doi: 10.1097/GOX.0000000000007337; Published online 6 January 2026.)  \nINTRODUCTION  \nBasal cell carcinoma is a common tumor of the ear, and surgical excision is generally the preferred treatment option. One of the most commonly affected areas is the helical rim. Mohs surgery can be an effective approach in such cases. As tumors in this location are often large, complex reconstruction techniques may be needed to close the defects after tumor removal. Here, we report the case of a patient who had a large tumor in this area and describe the flap we chose to use. This flap has not been described previously in the literature.  \nFrom the Dermatology Department, Hospital de la Santa Creu i Sant Pau, Teknon Medical Center, Autonomous University of Barcelona, Barcelona, Spain.  \nReceived for publication July 14, 2025; accepted October 8, 2025. Presented at the 33rd Meeting of the Spanish Group of DermatoOncology and Surgery, November 4–6, 2021, Seville; and The Catalan Conference on Skin Cancer, June 5, 2023, Barcelona. The data supporting the findings of this study are available from the corresponding author upon reasonable request.  \nCopyright © 2026 The Author. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.  \nDOI: 10. 1097/GOX.0000000000007337  \nMETHODS  \nCase Description  \nAn 88-year-old White man presented at our clinic for treatment of a primary basal cell carcinoma on his right ear. The tumor consisted of an erythematous, partially ulcerated, and poorly defined plaque of 3 × 1cm, involving more than one-third of the right helical rim (Fig. 1) . As optimal treatment to achieve complete removal of the tumor, we recommended Mohs surgery. We performed the surgery under local anesthesia. Three stages were needed for complete tumor removal. Bleeding was minimal, keeping the underlying cartilage undamaged. The resulting partial-thickness defect measured 5 × 1.5cm and was primarily centered on the mid-third of the right helical rim (Fig. 2) .  \nTechnique  \nSeveral basic principles must be taken into consideration during this type of surgery. It is necessary to ensure complete tumor removal, to restore the anatomical and aesthetic curvature of the","cbCaiovQ0ck6Rf6C","https://ap.wps.com/l/cbCaiovQ0ck6Rf6C","pdf",1152187,"English","# Summary\n# Introduction\n# Methods\n## Case Description\n## Technique\n# Takeaways","[{\"question\":\"Why is reconstruction of helical rim defects difficult after tumor removal?\",\"answer\":\"The ear’s unique anatomy makes it hard to restore the natural curvature, and large helical rim defects after skin tumor excision require careful surgical planning to avoid distortion and complications.\"},{\"question\":\"What surgical technique was used to reconstruct the reported defect?\",\"answer\":\"The defect was reconstructed using a double transposition flap harvested from the surrounding skin, with one flap covering the upper half and the other covering the lower half of the defect.\"},{\"question\":\"Was a cartilage graft needed in this case, and what were the outcomes?\",\"answer\":\"No cartilage graft was needed because the patient’s cartilage was not damaged during surgery. Both flaps survived without complications, and immediate and long-term outcomes were satisfactory with good cosmetic results.\"}]","A Novel Surgical Approach - Double Transposition Flap for Reconstruction of a Large Partial-Thickness Defect of the Helical Rim | PDF",1790701859]