Function-preserving anterolateral thigh flap reconstruction after auricular rhabdomyosarcoma resection in an adolescent: a case report

Auricular rhabdomyosarcoma is an extremely rare malignancy in the pediatric population, and its management presents unique challenges due to both oncologic and reconstructive considerations. Chemotherapy remains the cornerstone of treatment, but surgical intervention is indicated when the tumor demonstrates limited response to induction therapy or when durable local control is required. We report the case of a 16-year-old boy with rhabdomyosarcoma originating in the auricle and extending into the external auditory canal (EAC). He underwent wide local excision of part of the auricle, lateral EAC, and superficial parotid gland after a limited response to induction chemotherapy. Immediate reconstruction of the EAC was performed using a tubularized anterolateral thigh (ALT) flap, with the epithelial surface oriented outward to preserve canal patency and auditory function. Despite the inherent thickness of the ALT flap, this method achieved favorable outcomes, including successful postoperative radiation therapy, preserved hearing, and negative surgical margins. The patient remained disease-free with preserved auditory function and only minimal canal narrowing at the 5-year follow-up visit. This case demonstrates that ALT flap tubularization is a viable reconstructive technique, even for complex pediatric sarcoma cases. It provides a balance between oncologic safety, functional preservation, and long-term durability.