Review of 602 Microtia Reconstructions: Revisions and Specific Recommendations for Each Subtype

Sir: We read with interest the article entitled "Review of 602 Microtia Reconstructions: Revisions and Specific Recommendations for Each Subtype" by Kim et al., published in the July of 2020 issue of the Journal.1 As confirmed by several studies,2–4 we are in agreement with the authors on retaining the subcutaneous pedicle in the conchal area, for it creates a safer condition to perform bold skin flap trimming in the mastoid area. Furthermore, advanced expansion of insufficient postauricular skin with a tissue expander was necessary to overcome soft-tissue deficiency. However, we noticed in the article that a fair number of tissue expanders were used before the first stage of the Nagata method in subtypes other than anotia (see authors' Table 2). From the location of the tissue expander described in their Figure 2, dissection of the tissue expander pocket would probably damage the conchal subcutaneous pedicle. Unlike with anotia, the lobule of other subtypes was rotated in the first stage of the Nagata method, leaving the mastoid skin flap as the terminal region of the single cutaneous pedicle from the pocket margin, which caused necrosis to ensue. In our center, we avoid insufficient blood perfusion of the mastoid region by prolonged operation interval and delayed lobule rotation. Hence, we wonder whether necrosis and increased interventions were the consequences of introduction of the tissue expander, and whether the lobule rotation was delayed and counted in the number of revisions. DISCLOSURE The authors have no financial interest or conflict of interest to declare. No funding was received for this communication. Tongyu CaoShihi ChangYue WangBingqing WangQingguo ZhangDepartment of Ear ReconstructionPlastic Surgery HospitalChinese Academy of Medical SciencesBeijing, People's Republic of China