The width of the vestige is 6 mm, which is going to be split into 3 mm each for the anterior and posterior portion. The incision is then made for the flap. The asymmetry of the W flap is here again noted, with the mastoid portion not being equal to the anterior lobule portion but still forming a W shape. Here is the incision for the anterior tragal flap. The anterior lobule is split from the posterior lobule to form two flaps while ensuring the width of the two remains 3 mm each. Here, the anterior lobule flap is separated and brought to where it will be covering the lobule portion of the framework. Any vestige cartilage that is encountered should be removed. Dissection of the skin pocket should use small, straight, blunt scissors. The skin flap should be around 2 mm thick. Being able to adequately see the contour of the scissors is a good sign that the skin flap is adequately thin. It is imperative to not undermine the subcutaneous pedicle while dissecting the skin pocket. This large pedicle does not contain any identified vessels, but it contains several perforator vessels that are not pinpoint or coalesced in a thin stalk. Once again, the anterior lobule flap is brought to where it will be covering the lobule portion of the framework. Together, the posterior lobule flap and mastoid flap form a U-shape, and the excess skin at their junction create a concavity that will be used to cover the concha.

surgical flaps

anterior lobule

posterior mastoid

incision technique

skin flap thickness