Cartilage exposure following autologous microtia reconstruction: An algorithmic treatment approach

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2019-03, Vol.72 (3), p.498-504
• Main Authors: Cugno, Sabrina, Bulstrode, Neil W.
• Format: Article
• Language: English
• Subjects: Adolescent; Algorithms; Cartilage exposure; Child; Congenital Microtia - surgery; Ear Cartilage - surgery; Ear reconstruction; Fascia flap; Female; Humans; Male; Microtia; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Postoperative Complications - surgery; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Reoperation - methods; Retrospective Studies
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2018.11.006

Successful reconstruction of microtia involves fabrication of a cartilaginous framework and provision of thin, durable, soft tissue cover. Vascular compromise of this skin envelope can lead to exposure of the underlying cartilage, resulting in cartilage resorption and distortion of the final form of the ear construct. We describe our algorithm for management of this complication. All patients who underwent autologous ear reconstruction by a single surgeon (NWB) from April 2006 to September 2012 were retrospectively reviewed to identify any that developed exposure of the underlying cartilage framework. Details related to timing, location, size and management of the cartilage exposure were collected. From a total of 230 autologous auricular reconstructions (median age at first stage, 11.4 years), 15 exposures of the cartilage framework were identified. All exposures occurred following the first stage of reconstruction (mean of post-operative day 29, range, 7–86 days). Large areas of exposure (> 10 mm2) required surgical management, with debridement and coverage with either a cutaneous or fascial flap, depending on the location. Areas