The three-dimensional nature of the ear with its many curves, peaks, and valleys demands the utmost attention to detail. Yet as challenging as it may seem, reconstruction of the ear can be made easier and predictable if one understands the surgical principles and anatomy.

The external ear is composed of skin and cartilage with the supporting nerves and blood vessels. The auricular cartilage provides a framework for all but the lobule of the ear. The tightly adherent skin extending from the preauricular sulcus to the helix produces distinct topographical landmarks that are important in understanding and describing the anterior ear.

Flaps, grafts, and primary linear closures can all be used in reconstruction of the ear. Healing by second intention is also a valuable tool. Deciding which reconstruction technique is best suited for a given defect depends upon its size and location. The goal is to restore the shape, size, and alignment of the ear. An important principle in ear reconstruction is that the entire anterior surface of both ears cannot be viewed simultaneously. It is therefore important to reconstruct the ear so that it is not distorted or deformed, but it need not exactly match the contralateral ear in size and appearance.