Single-Stage Reconstruction of a Complex Full-Thickness Auricular Defect Following Excision of Rapidly Progressive Squamous Cell Carcinoma in a 100-Year-Old Patient: A Case Report.

Auricular reconstruction following oncologic excision remains challenging because of the complex three-dimensional anatomy of the ear, limited local tissue reserve, and the need to preserve contour, projection, and external auditory canal patency. Large full-thickness defects involving multiple auricular subunits are particularly difficult to reconstruct without substantial alteration of auricular dimensions or the need for cartilage grafting or staged procedures. This case describes a 100-year-old woman with a rapidly progressive auricular lesion involving the right helix, antihelix, and a portion of the conchal bowl. Serial clinical photographs obtained 19 days apart during the preoperative evaluation documented substantial interval progression of the lesion. Gross pathological examination documented a lesion measuring 4.4 × 3.9 cm within a surgical specimen measuring 5.5 × 4.4 × 2.4 cm. Histopathological examination confirmed an invasive, ulcerated, well-differentiated squamous cell carcinoma (SCC) with cartilage involvement and negative surgical margins. Following excision, a substantial full-thickness auricular defect involving multiple contiguous subunits remained. Immediate reconstruction was performed in a single stage using a three-component local tissue approach consisting of bidirectional advancement of the residual superior and inferior helical segments combined with anterior recruitment of posterior auricular skin. This strategy was designed to restore helical continuity, provide soft-tissue coverage, and preserve as much of the remaining native auricular framework as possible without cartilage grafting or a planned staged reconstruction. Postoperative healing was uneventful, without flap necrosis, wound dehiscence, infection, or other major complications. At 76 days of follow-up, the reconstructed auricle demonstrated healed soft-tissue coverage, maintenance of overall auricular contour and projection, and external auditory canal patency. This case illustrates the feasibility of combining residual helical and posterior auricular tissues as a single-stage reconstructive option for selected complex full-thickness auricular defects when adequate viable local tissue remains. Longer follow-up and objective postoperative measurements are needed to assess long-term dimensional stability and durability.