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By Norman M. Bradburn

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After exteriorizing the ear, the skin is returned to its old retroauricular bed (Fig. 20). The dermabraded auricular parts of the anterior and posterior surfaces, which are initially nourished by the enveloping pocket and the mastoid bed, begin to reepithelialize. If there is no sign of any spontaneous epithelialization, the raw area is covered with a split-thickness skin graft. Following animal studies conducted by Mladick et al. (1971), Mladick and Curraway (1973) subsequently modified and improved the pocket technique.

We reject selective neck dissection without proof of metastatic lymph node involvement (Garbe 1995). If involvement is confirmed, selective, and at times even radical, neck dissection is undertaken. Radiotherapy. We prefer excisional biopsy. Once the cartilage has been invaded, however, the prospects of cure are lower, with the 5-year cure rate being reported as below 50 % (Ledermann 1965; Hansen et al. 1968). In tumors where surgical cure is no longer feasible because the invasion is too deep, or that are inoperable for other reasons, combination therapy should be considered, involving palliative surgical measures (laser surgery or cryosurgery) and subsequent irradiation, or a combination of chemotherapy and radiotherapy.

4). 7). 5), with about half being human bite injuries. Theoretical Principles Usually partial or total auricular loss involves a threelayered avulsion, which may be repaired using various techniques. When the entire external ear has been lost there is always the temptation to reattach the completely avulsed tissue segment, but, depending on the size of the replant, a high rate of loss must be expected due to trophic disturbances resulting from the very restricted nutrient base (Brown et al. 1946; Haas and Meyer 1973 a; Kotthaus et al.

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