Congenital preauricular fistula is a common clinical condition of the congenital external ear. Only by removing the fistula and clearing the lesion can the infection be completely controlled and the preauricular fistula be cured. Repeated infections of the preauricular fistula and the proliferation of granulation and scar tissue around it after incision and drainage of pus for medication increases the extent of surgical excision and causes local soft tissue defects. For small skin defects, a subcutaneous separation can be made to reduce the tension and intermittent suturing of the subcutaneous tissue and skin. If the skin defect is large, the wound can be covered with petroleum jelly gauze and left to repair itself or with a second-stage skin graft. After satisfactory excision of the lesion, the skin incision is reinforced with sutures and the surgical wound is caulked with sterile gauze, and the incision is sutured in stage II. In pediatric patients, this can be extremely painful and mentally taxing. The defect is repaired in one stage using a retroauricular flap, which has the following advantages: 1. It is located behind the ear, relatively concealed, and the postoperative scar is not obvious. At the same time, the skin in this area is relatively loose, and the flap can be sutured directly without causing displacement or deformation of the surrounding organs; 2, it does not require dissection of blood vessels and is easy to operate; 3, the flap is similar in color and texture to the skin in front of the ear, and the appearance is satisfactory after healing; 4, the surgery can repair the wound in one stage, which can reduce the economic burden and reduce the psychological trauma and mental stress of the child. At the same time, the following points need to be noted: 1, for the repair of trauma with large skin defects that are difficult to be sutured directly; 2, the tip of the flap is located in the temporal area above the affected ear wheel, and the length to width ratio of the flap should not exceed 3:1; 3, the thickness of the flap is similar to the depth of the soft tissue defect in front of the ear; 4, to prevent distortion or excessive stretching in the flap transfer; 5, the flap area is properly wrapped with pressure 48 hours after surgery to increase the contact area between the flap and the base of the trauma. This is to increase the contact area between the flap and the base of the trauma, which is conducive to the establishment of blood supply and can prevent the accumulation of blood and fluid under the flap to ensure the survival of the flap, while the tip of the flap should not be wrapped with pressure to avoid affecting the blood supply; 6, avoid the use of vasoconstrictive drugs. We believe that postauricular tipped flaps can provide an effective treatment for larger skin defects after preauricular fistula surgery in children, are less painful and more cosmetically pleasing than second-stage implants and other techniques, and are worthy of application in pediatric patients.