Autogenous rib cartilage reconstruction of congenital ear defects: report of 110 cases with Brent's technique

Abstract

The purpose of this study was to confirm the feasibility of Brent's technique, which was adopted for the treatment of the patients in this series. The author reports his experience with the successful treatment of 110 consecutive patients born with unilateral 95 (86.4 percent) and bilateral 15 (13.6 percent) microtia. The main stages of the reconstruction process are described, from the initial consultation to completion of treatment: reconstruction with sculpted rib cartilage graft, lobule transposition, tragus construction, and construction of the retroauricular sulcus. Minor modifications of Brent's technique for the last surgical stage are described. The author stresses use of autogenous rib cartilage as basic reconstruction material and emphasizes meticulous carving and assembling of frameworks, for which a balanced blend of structural firmness and aesthetic smoothness is essential. The author also describes complications and their management; cases of abandonment of treatment before completion; and difficulties encountered for long-term follow-up. Specially encouraging was the low proportion of short- and long-term complications: one case of hematoma (0.91 percent), one case of infection, two cases of partial skin loss (1.82 percent), and three cases of hypertrophic scars (2.73 percent). Older patients were more prone to abandon treatment before completion of all surgical stages (p = 0.000243) in this series, and this tendency occurred more frequently during the author's early experience in treating microtia patients. Despite the difficulty of the task, this series corroborates the versatility and feasibility of the technique in different geographical areas and population groups.