Can two-stage surgical auricle reconstruction with an integrated treatment process improve efficiency, effectiveness, and satisfaction in adults with congenital microtia?
Explore This IssueSeptember 2023
A two-stage treatment strategy is a versatile, reliable, and effective congenital microtia treatment.
BACKGROUND: Total auricle reconstruction for patients with congenital microtia is challenging due to the unique physiological characteristics of the costal cartilages and retroauricular skin. Few studies have examined the use of an integrated treatment process, in which different perspectives and technical modifications are applied, in adult microtia.
STUDY DESIGN: Retrospective study.
SETTING: Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
SYNOPSIS: Researchers identified 346 adult patients who received primary reconstructions for congenital microtia using a rigorous preoperative evaluation and stages one and two surgeries at a single institution between 2006 and 2021. Preoperative planning included computed tomographic scans and 3-D reconstructions of the chest to analyze costal cartilage for optimal harvest selection, use of tissue expanders for patients with an extremely low hairline or tight mastoid skin, and moderately raised elevation to compensate for bony asymmetry. Stage one included autologous costal cartilage harvest, framework fabrication, pocket dissection and framework placement, and earlobe transposition and negative suction drain. Stage two included ear elevation using modifications to the prefabricated elevation pad, retroauricular fascial flap, and skin graft. Patients were followed up for six months to 10 years. Overall, the postoperative complications rate was 8.1% and included cartilage exposure, broken helix, local hematoma, infection, poor graft survival, and scar hypertrophy. Stage one accounted for 74.1% of all complications. Aesthetically pleasing results were obtained from the integrated process. Study limitations included the single-institution source.
CITATION: Li H, Wang Y, Qian J, et al. A two-stage method for adult congenital microtia: the essentials of 15-year experience. Laryngoscope. 2023;133:2148–2153.