Reconstruction of Upper and Lower Eyelids with Auricular, Postauricular, and Retroauricular Scalping Flap with Cartilage Flap

1 Koichi Ueda, MD, PhD Jun Akamatsu, MD, PhD Naoya Sugita, MD Yuka Shigemura, MD Takashi Nuri, MD, PhD Department of Plastic and Reconstructive Surgery Osaka Medical College Takatsuki Osaka, Japan Department of Plastic and Reconstructive Surgery Chikamori Hospital Kochi, Japan Sir: T postauricular and retroauricular scalping flap (PARAS), described by Dias and Chhajlani,1 has a profuse circulation from the contralateral superficial temporal vessels. The PARAS flap is described as a skin flap. Our modification adds preauricular skin and a portion of helical cartilage and combines conchal cartilage with postauricular skin. It is called an auricular, postauricular, and retroauricular scalping flap with cartilage flap (APARASC flap) (Fig. 1). A 66-year-old man had developed a tumor on his left cheek 10 years back but received no treatment. The tumor spread slowly and widely and became ulcerated. A biopsy revealed basal cell carcinoma. The ulcerative lesion spread to the upper and lower eyelids. CT scan and MRI showed no cervical metastatic lymph nodes or other metastatic lesions. The ulcerative cancer