PMC9793907_01
The first visit. Redness, swelling, necrosis, and pus in the right ear.
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The right auricle and the surrounding temporal area were erythematous and swollen (Figure 1).
First surgery. (A) Necrosis from the subcutaneous tissues to the temporal fascia. (B) After the necrotic tissue excision, the temporalis muscle is exposed. (C) Creating the temporalis muscle flap. (D) The temporalis muscle flap is covered over the detached auricle.
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To salvage the auricle, the temporalis muscle flap was elevated above the periosteum and inverted to cover the auricle (Figure 2).
Second surgery, 12 days after. (A) After debridement, the extracranial plate is exposed. (B) Applying NPWT (RENASYS  TOUCH, Smith & Nephew) with a negative pressure of -120 mmHg.
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Negative-pressure wound therapy (NPWT) was started at the end of surgery (Figure 3).
Third surgery, 26 days after. (A) The extracranial plate is removed to the depth where petechial hemorrhage. (B) Artificial dermis (TERUDERMIS(R), Olympus Terumo Biomaterials Corp) is placed.
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Because of the exposed temporal bone, the extracranial plate was shaved until petechial hemorrhage could occur, and the artificial dermis was applied (Figure 4).
Reconstructive surgery, 66 days after. (A) Preoperatively, the auriculotemporal sulcus has disappeared. (B) VY advancement flap in the auricle. (C) The auriculotemporal sulcus is created. (D) Skin grafting on the temporal area.
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The ulcer surface of the temporal region was covered with a split-thickness skin graft from the parietal region (Figure 5).
At 7 months after reconstructive surgery. (A) The auricular temporal sulcus is clear. (B) The shape of the auricle is good.
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After 7 months, the auricle and graft were provided with better outcomes (Figure 6).