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Surgical Technique
Sep 2011

Cryptotia RepairA Modern Update to the Trefoil Flap

Author Affiliations

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery, Madigan Army Medical Center, Tacoma (Dr Adams), and Seattle Children's Hospital, Seattle (Drs Cushing and Sie), Washington.

Arch Facial Plast Surg. 2011;13(5):355-358. doi:10.1001/archfacial.2011.60

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.