Objective To investigate the efficacy and short-term prognosis of the treatment of complex preauricular fistulas by double-incision tunneling combined with total resection of preauricular tissue and cartilage. Methods The data on 134 children with complicated preauricular fistula admitted to the hospital from January 2018 to July 2022 were retrospectively analyzed. According to the treatment method， they were divided into a study group （68 undergoing double-incision tunnel combined with preauricular tissue and cartilage resection） and a control group （66 receiving preauricular tissue and cartilage resection）. Both groups were followed up for one year. The conditions of surgery， pain， postoperative incision healing， aesthetics of incision healing， complications and short-term prognosis were compared between the two groups. Results There was no significant difference in the amount of blood loss between the two groups （P > 0.05）. The surgical duration was longer in the study group than in the control group （P < 0.05）. There was no significant difference in Pain Behavior Scale （FLACC） scores between the two groups at hours 4 and 24 after surgery （P > 0.05）. There was no significant difference in wound healing between the two groups （P > 0.05）. The SBSES score of the study group was higher than that of the control group （P < 0.05）. There was no significant difference in the total complication rate between the two groups （P > 0.05）. No recurrence occurred in both groups during postoperative follow-up. Conclusion Double-incision tunnel combined with resection of preauricular tissue and cartilage for preauricular fistula can completely remove fistula tissue. Incision healing is satisfactory， safe and reliable. As compared with the total excision of preauricular tissue and cartilage， double-incision tunnel combined with total excision of preauricular tissue and cartilage has more advantages in aesthetics of incision healing.