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Surgical Technique |

Cryptotia Repair:  A Modern Update to the Trefoil Flap

Mary Theresa A. Adams, MD; Sharon Cushing, MD, MSc, FRCSC; Kathy Sie, MD
Arch Facial Plast Surg. 2011;13(5):355-358. doi:10.1001/archfacial.2011.60.
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Cryptotia is a congenital anomaly in which the superior aspect of the helical cartilage is buried beneath the scalp, resulting in an absence of the auriculocephalic sulcus. Treatments have included splinting, skin grafts, and a variety of local flaps. We present a modification of the trefoil flap, initially described by Wesser in 1972. The modifications include wider undermining of the opposing trefoil flap (≤2-4 cm), staggering the closure of the helical apices, and expanding the base of the auricular trefoil flap such that it extends over a larger circumference of the helical rim. The senior author (K.S.) has achieved excellent results with this method and has alleviated the need for skin grafts or local preauricular flaps to close the donor site.

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Figures

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Figure 1. Schematic of modified trefoil technique for correction of cryptotia. A, Surgical marking (dotted line represents buried helical rim). B, Flap elevation with wide undermining (≤2-4 cm) (arrows). C, Approximation of scalp flaps. D, Approximation of auricular flaps. E, Closure with staggering of the apices of the scalp and auricular trifurcations. F, Postoperative appearance.

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Figure 2. Intraoperative photographs outlining modified trefoil technique for correction of cryptotia. A, Preoperative appearance of a cryptotic ear with surgical marking (dotted line represents buried helical rim). B, Flap elevation with wide undermining (≤2-4 cm). C, Approximation of scalp flaps. D, Approximation of auricular flaps. E, Closure with staggering of the apices of the scalp and auricular trifurcations. F, Postoperative appearance.

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