Introduction: Maintaining precise ear contour remains a challenge for traumatic and congenital ear reconstruction. To address this problem, we have developed a novel composite axial pattern pre-fabricated ear flap that retains contour by virtue of planned cartilage graft remodeling within an vascularized flap. The accurate reproduction of ear cartilage is facilitated by a negative silicone mold. Grafting on the surface of this cartilage is enabled by vascularization of an acellular dermal covering.

Method: The entire procedure is performed in 2 stages 3 months apart. We describe the technique’s use in the setting of both traumatic and congenital ear defects. We were able to maintain structural definition and retain a vascularized neo-dermal layer over the cartilage that allowed superior take of anterior skin grafts.

Conclusion: This pre-fabricated ear flap schema is a novel permutation of the traditional superficial temporoparietal fascia flap. It integrates silicone molds and acellular dermis to yield a composite, axial pattern ear flap which reconstructs the defect in precise, durable, three-dimensional fashion while maintaining robust vascularity on all surfaces.