Microtia Reconstruction: Our Strategies to Improve the Outcomes

Abstract

Introduction : Autologous costal cartilage framework placement is currently the gold standard in patients with microtia. In this article, we present the modifications developed by the author, generally following the principles established by Nagata, and discuss the technical details that have led us to achieve consistently stable and good long-term outcomes for auricular reconstruction in microtia. Materials and Methods : A retrospective review of microtia reconstruction performed from 2015 to 2021 was done. Those who underwent primary reconstruction for microtia and with a minimum follow-up of 6 months with documented photographs were included. Those who underwent secondary reconstruction for microtia and those who did not follow-up for a minimum period of 6 months were excluded. Outcomes were assessed with regard to appearance, and durability of the result. Influence of certain changes like delaying reconstruction until 15 years of age, use of nylon for framework fabrication, etc. over the outcome were assessed. Results : Of 11 ears reconstructed at less than 15 years of age, only one patient (9%) had a good long-term outcome, whereas of the 17 ears reconstructed at greater than 15 years of age, nine patients (53%) had a good long-term outcome. In our experience, infections and wire extrusions were the significant events related to severe cartilage resorption. Conclusion : In our experience, delaying the first stage to 15 years or later, using double-armed nylon sutures, and reducing the projection of the third layer of the framework in select cases have helped to improve our outcomes. Second stage of reconstruction can be avoided if patient is satisfied with the projection achieved in the first stage.

Keywords: ear framework fabrication; improving outcomes of ear reconstruction; microtia reconstruction; single-stage ear reconstruction; wire extrusion.

Fig. 1

First stage of microtia reconstruction: preoperative marking ( A ); split lobule with fine vessels preserved at base of flap ( B ); 6, 7, and 8 costal cartilages harvested ( C ); cartilage framework ( D ); immediate postoperative result—note suction drain system created using 16G cannulas ( E ); and final result 1.5 years later ( F ).

Fig. 2

A 19-year-old male with right lobule type microtia ( A ). Preoperative markings of subcutaneous pocket, lobule splitting incision, template, and superficial temporal artery ( B ) and a framework fabricated with 4-0 Nylon ( C ) result in the lateral, anterior, and posterior ( D , E , and F ) views 1.5 years post surgery.

Fig. 3

A 28-year-old lady with right lobule type microtia ( A ). Preoperative markings of subcutaneous pocket, incision to transpose lobule, template, and superficial temporal artery ( B ) and a multipiece framework fabricated with 4-0 Nylon ( C ) result in the lateral, anterior, and posterior ( D , E , and F ) views 1.5 years post surgery.

Fig. 4

Second stage: Incision planned for framework elevation and temporoparietal fascia harvest ( A ). Elevation of framework ( B ). Banked cartilage placed ( C ). Securing cartilage block to the framework with 3-0 PDS ( D ). Temporoparietal fascia flap covers the cartilage ( E ). Harvesting split thickness graft from adjacent scalp ( F ) and covering temporoparietal fascia with the skin graft ( H ). The hair in the skin graft is removed manually ( G ).

Fig. 5

An 18 year old male with left lobule type microtia ( A ). Result after stage 1 reconstruction ( B ). Secondary correction 3 months after the first stage ( C ). Note the inadequate projection after stage 1 ( D ). Result after second stage, that is, framework elevation (done 6 months after the first stage) ( E ). Silicone ring splint ( F ). Final appearance without splint ( G ). The final result 7.5 years post surgery, note improvement in projection ( H ).

Fig. 6

A 13-year-old girl with lobule type microtia ( A ). Post stage 1 reconstruction; stable result for about a year ( B ). Late extrusion of multiple stainless steel wires ( C ). Resorbed cartilage after 2 years ( D ).

Fig. 7

An 18-year-old male with left lobule type microtia ( A ). Framework fabricated using both stainless steel wires and nylon sutures ( B ). Immediate postoperative result ( C ). Secondary corrections and second-stage elevation are depicted in Figs. 4 and 5 . Result after 2.5 years after both stages of reconstruction ( D , E , and F ).