Reconstruction of Microtia Using a Single Expanded Postauricular Flap without Skin Grafting: Experience of 683 Cases

Background: Auricular reconstruction of congenital microtia patients is a huge challenge for plastic surgeons worldwide. Current techniques usually use a retroauricular fascial flap with skin grafting, often proving to be color mismatched, complex, and with visible scarring. An uncomplicated strategy that results in minimal scarring and a good color match is still required, especially for Asian patients. In the present work, the authors developed a modified technique for auricular reconstruction using a single expanded flap combined with a cartilage framework. Methods: Auricular reconstruction was performed in three stages. In the first stage, an 80-ml kidney-shaped expander was inserted in the mastoid region. A gradual expansion period of approximately 2 to 3 months was implemented until the flap achieved an appropriate area, thickness, and softness. In the second stage, the expander was removed and a modified three-layer cartilage framework was inserted into the pocket through the same incision. In the third stage, the reconstructed ear underwent further refinements, including reconstruction of the earlobe and tragus. Results: From January of 2012 to January of 2017, 683 microtia patients (a total of 738 ears) were selected for auricular reconstruction using this technique. The patients were followed up for between 3 months and 2 years. Six hundred forty-two patients were satisfied with the final results regarding the size, shape, projection, symmetry, and clarity of outline. Surgery-related complications occurred in 20 patients. Conclusion: Auricular reconstruction using a single expanded flap combined with a modified three-layer cartilage framework is an effective and efficient technique for microtia reconstruction with satisfying medium-term results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.