To introduce refinements to the original single-stage technique published in 2018, described for delayed reconstruction of partial subtotal defect of the helical rim and antihelix.

Cases performed by the senior author (MA) were included, with important tips introduced to refine and standardise the technique to improve outcomes. These refinements extend the use of the technique to the reconstruction of larger defects than previously described, the use of contralateral conchal cartilage and carved rib cartilage graft, and the use of quilting sutures with the dental bolsters to support the post-auricular sulcus.

The refinements used contralateral conchal cartilage grafts for defects up to 4 cm and autologous rib cartilage graft for defects more than 4 cm.

This versatile and reliable technique should be considered the standard technique for patients presenting with delayed helical rim defects. It produces satisfactory aesthetic results in terms of size and shape.

Middle-third helical rim defects may arise from trauma or oncological resection, and pose a challenging reconstructive problem. Reconstructing defects larger than 2 cm using traditional methods commits patients to the inconvenience of staged procedures.

This paper describes a single-stage helical rim reconstruction technique using a post-auricular bipedicled flap and ipsilateral conchal cartilage graft for delayed middle-third helical rim reconstruction.

Two examples of this technique used in post-trauma and oncological reconstruction cases are presented, with pre- and post-operative photographs provided for demonstration.

Contralateral graft harvest and staged operations for helical rim reconstruction are associated with donor site morbidity and the inconvenience of multiple operations to achieve the desired reconstructive outcome. Our single-stage helical rim reconstruction technique was well tolerated by patients, and showed satisfactory aesthetic results in terms of size and symmetry.