Ear Reconstruction Following Human Bite Injury

Background: Auricular reconstruction following traumatic injuries presents significant challenges, particularly when patient expectations restrict the use of traditional reconstructive options. Human bite injuries, though uncommon, often result in complex tissue loss, contamination, and aesthetic deformity that require carefully tailored management.

Case Presentation: We report the case of a 27-year-old Bahraini male who presented with a middle-third helical rim defect of the left ear following a human bite injury sustained in March 2024. The initially sutured avulsed flap subsequently became necrotic, resulting in a noticeable contour deformity. The patient had sought multiple opinions and expressed specific concerns, including preservation of ear size and contour, avoidance of visible donor-site scars, and refusal of skin grafts or bulky staged flap procedures.

Management: Several reconstructive options were evaluated, including the Antia-Buch chondrocutaneous advancement flap, bi-pedicled flaps, tubed flaps, and modified post-auricular or retro-auricular techniques. A customized modification of these established approaches was ultimately selected to restore the natural auricular contour while accommodating the patient’s aesthetic expectations and procedural limitations.

Outcome: The chosen technique provided satisfactory structural and cosmetic restoration of the helical rim without reducing ear size or requiring grafts. The patient achieved a natural contour, expressed high satisfaction with the aesthetic result, and experienced no postoperative complications.

Conclusion: This case underscores the importance of patient-centered planning in auricular reconstruction. The Antia-Buch flap and its modifications continue to serve as reliable, single-stage solutions for helical rim defects, particularly in patients who decline traditional donor-site or staged reconstructive methods.

Credit: Case managed and reported by Dr. Madhusudana, Consultant Plastic Surgeon, Bahrain Specialist Hospital.