The goal of auricular reconstruction is to achieve a natural appearance of the reconstructed side with a form that resembles the normal ear and endures over a lifetime. For severe deformities in which major cartilaginous elements are missing, established reconstructive techniques using alloplastic constructs wrapped in temporoparietal fascia or carved costal cartilage grafts may be employed. For cases of minor deformity in which all named cartilaginous components are present, albeit deficient compared to the normal side, transfer of autologous auricular skin and cartilage may be used to achieve symmetry between normal and abnormal ears. This video presents the surgical technique and results of a grade 1 microtia reconstruction using autologous auricular cartilage transfer. This two-stage method of reconstruction avoids the use of autologous rib or alloplastic materials and often avoids the use of skin grafting altogether.
Two Stage Grade 1 Microtia Repair Using Autologous Auricular Cartilage Transfer
Unilateral grade 1 microtia, length discrepancy between ears of <20mm
Bilateral microtia, severe grade 2 or grade 3 microtia, Prior auricular surgery or significant trauma to either ear that may compromise graft viability or vascularity to recipient bed. Smoking or tobacco exposure.
Standard soft tissue instruments, fine forceps, skin hooks / fine double prong retractors, calipers or ruler, sterile transparency (1000 drape), sutures (5-0 clear PDS, 5-0 vicryl, 5-0 fast-absorbing plain gut, 6-0 fast absorbing plain gut), xeroform gauze and cotton. For second stage 4-0 Mersilene sutures may be required for reconstructive otoplasty.
Detailed physical exam including accurate measurements of the dimensions of the donor and recipient auricle.
Named structures of normal (donor) ear should be studied to plan orientation of wedge-shaped composite graft. This is planned in a way to minimize donor site deformity and optimize symmetry compared to the newly-reconstructed auricle
Advantages: avoids the use of autologous rib or alloplastic materials and often avoids the use of skin grafting altogether. Excellent color match of skin transfer as it comes from the other ear.
Disadvantages: imparts a size reduction to the otherwise normal-sized contralateral ear, exposes normal ear to potential donor site infection, scarring, or deformity. Composite graft is prone to necrosis and viability is tenuous and subject to local factors such as infection, hygiene, and vascular compromise. A two staged procedure is still required.
Bleeding, infection, deformity and/or scarring of either ear. Partial or complete graft loss, need for further procedures / revisions.
The case presented in the video was performed with Dr. Mark A. Vecchiotti as assistant surgeon.
Cheney M L, Hadlock T A, Quatela V C. Reconstruction of the auricle. In: Baker S R, editor. Local Flaps in Facial Reconstruction. Edinburgh: Elsevier Mosby; 2007. pp. 581–624.