IDEAS AND INNOVATIONS
Caudal Antia–Buch reconstruction for helical defect
reconstruction: Burow’s triangle always in the lobule
B. B. G. M. Franssen
M. R. Frechner
Received: 20 May 2009 / Accepted: 12 January 2010 / Published online: 17 February 2010
Abstract Different reconstructive techniques regarding
helical ear defect reconstruction exist. The best cosmetic
results are achieved using the modified Antia–Buch
chondrocutaneous advancement flaps. In addition to this
flap when it is caudally based, we always place Burow’s
triangle in the earlobe. This technique provides the most
normal cosmetic appearance of the ear without the need for
a cranial-based flap in most cases.
There are several different reconstructive techniques used to
repair helical rim defects. Wedge excision is a technique
which is excellent for small upper pole defects. The
disadvantages of this technique, however, are cupping,
webbing, and butterfly deformity which results from
circumference and radius reduction [1, 2].
In 1967, Antia and Buch developed and introduced
combined cranial and caudally based chondrocutaneous
advancement flaps for the marginal defect of the ear .
This advancement flap makes a single-stage reconstruction
of helical rim defects possible.
In 1996, Calhoun showed satisfactory closure of helical
rim defects up to 20 mm by extending the inferior incision
into the earlobe, creating a Burow’s triangle and shaving
cartilage from the scapha. Alternatively, when using a
Burow’s triangle, Calhoun excised the full thickness, e.g.,
skin and cartilage .
In 1998, Low provided additional cutaneous coverage
using a modification which included anterior cutaneous
flaps based on the helical flaps. This technique preserves
ear size and shape and avoids the need for a skin graft or
postauricular grafts .
One year later in 1999, Bialosocki described the concept
of crescentic scaphal excision and an advancement-
rotation flap . Finally in 2003, Butler described
excision of anterior scaphal skin and cartilage to reduce
the length of helical rim necessary to reestablish the
helical contour .
All the authors, Ramsey , Calhoun , Narayan ,
and Butler , described excision of a Burow’s triangle if
there is significant tension or lobule deformity due to
movement of the advancement flap. All of these authors
placed the Burow’s triangle at different places.
Although not specifically emphasized, Ramsey  and
Butler  placed the Burow’s triangle in the earlobe. We
think this is the most logical place because this is the place
with the most excess tissue in this area. The bigger the
Burows triangle, the greater amount of advancement can be
achieved. It is not surprising that in many articles where the
Burows triangle is placed elsewhere, often-combined
cranial and caudal based flaps are necessary. We used this
procedure with only a caudal flap with very good results in
lateral helical defects up to 2 cm.
A defect (Fig. 1), up to 2 cm including skin and cartilage of
the helical rim, is made (Fig. 2). The skin and cartilage of
B. B. G. M. Franssen (*)
M. R. Frechner
Maxima Medical Center,
Veldhoven, The Netherlands
Eur J Plast Surg (2010) 33:105–107