Two-stage reconstruction of the auricle in congenital microtia using autogenous costal cartilage

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2007-01, Vol.60 (9), p.998-1006
• Main Authors: Cho, Byung Chae, Kim, Jong Yeop, Byun, Jin Suk
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Cartilage - transplantation; Child; Costal cartilage; Ear, External - abnormalities; Ear, External - surgery; Esthetics; Female; Follow-Up Studies; Humans; Male; Medical sciences; Microtia; Middle Aged; Plastic Surgery; Reconstructive Surgical Procedures - methods; Ribs; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps; Surgical Wound Infection; Treatment Outcome; Two-stage reconstruction
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2005.12.052

Summary The current authors reconstructed the auricles of congenital microtia patients with a two-stage method using autogenous costal cartilage. In the first stage, lobule rotation, fabrication of the cartilage framework, and implantation of the framework were performed. In the second stage, elevation of the auricle using transplantation of the costal cartilage and two local transposition flaps, formation of the tragus, and deepening of the concha were performed. A total of 125 consecutive patients were treated, ranging from seven to 53 years old, from 1990 to 2003. Sixty-nine patients were males and 56 patients were females. Unilateral microtia was present in 114 patients (right 73, left 41), bilateral in 11 patients. Ninety-four cases were the classic sausage-shaped lobule type deformity; the remaining 42 cases presented concha-type deformity. The follow-up period was 6 months to 10 years. One hundred and eighteen cases presented acceptable ear contour after ear reconstruction. Unfavourable results were blunted convolution of the reconstructed ear because of thick fibrous tissue in six cases, mild absorption of carved cartilage by infection in two cases, deformation of the constructed helix occurred in four cases, less projection of the elevated ear in three cases, and hypertrophic scars in three cases. Our procedure produced acceptable contour of the reconstructed auricle with fewer complications than conventional procedures. In addition, careful meticulous manipulation is necessary to create natural contour of the ear and to reduce complications in all stages.