This patient had a near total ear defect including the bone beneath and behind the ear related to an advanced skin cancer involving the ear. Her reconstruction required a multi staged approach to restore the ear. In stage one, a tissue expander was placed beneath the forearm skin to slowly stretch the skin. In the second stage, an ear framework was created using rib cartilage and inserted beneath the thinned forearm skin to incubate for three months. In the third stage, the forearm skin and underlying cartilage framework were transplanted from the forearm to the ear defect as a free flap to restore the missing tissue.