Updated: May 31, 2026

Surgical Approach to Full Soft Tissue Face Allograft Procurement for Vascularized Composite Allotransplantation
Published on: December 30, 2025
1The Department of Plastic and Reconstruction, Union Hospital, Tongji Medical College, Huazhong Science & Technique University, No. 1277, Jiefang Dadao Road, Wuhan, China. liujiafengfeng@126.com
This article introduces a new surgical method for reconstructing a full ear without using skin grafts. The method uses two tissue expanders implanted in the scalp and behind the ear to generate enough skin for coverage. In the second stage, expanded skin flaps and a fascial flap are used to wrap the cartilage framework. The final stage forms the pseudomeatus and tragus. The authors claim this approach eliminates the need for skin grafts and reduces complications from skin shortages.
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Area of Science:
Background:
Reconstructing an entire ear requires two key components: a structural framework and a covering skin layer. While cartilage frameworks are well-established, skin coverage remains a challenge due to limited availability. Traditional methods often struggle with insufficient skin, leading to complications. Surgeons have long sought solutions to this limitation. Some approaches use skin grafts, but these can cause donor site morbidity. Others rely on tissue expansion but with limited success. The need for a reliable skin coverage method persists. This paper introduces a novel three-stage surgical method. The method aims to address the persistent issue of skin deficiency in ear reconstruction.
Purpose Of The Study:
The goal of this research is to present a new method for total auricular reconstruction that eliminates the need for skin grafting. The approach uses tissue expansion to generate sufficient skin for coverage. The method is designed to avoid donor site complications from grafts. It combines tissue expanders with autogenous rib cartilage. The three-stage process is intended to ensure complete skin coverage. The first stage involves implanting two tissue expanders. The second stage raises expanded skin flaps and constructs the framework. The third stage completes the pseudomeatus and tragus formation.
The method eliminates the need for skin grafting by using two tissue expanders to provide sufficient skin coverage.
Two tissue expanders are implanted in the first stage: one beneath the scalp and one behind the microtic ear.
The fascial flap wraps the framework from beneath and is covered by the lower expanded skin flap.
The upper flap covers the anterior surface of the framework and drapes over the fascial flap.
The pseudomeatus and tragus are formed in the third stage of the procedure.
Main Methods:
The method involves a three-stage surgical process. First, two tissue expanders are implanted: one beneath the scalp and one behind the microtic ear. The second stage includes lobule transposition and raising expanded skin flaps. The upper and lower expanded flaps are combined with a mastoid fascial flap. Autogenous rib cartilage is harvested and shaped into a framework. The framework is anchored between the upper skin flap and fascial flap. The inferior pole is inserted into the rotated earlobe. The third stage involves forming a pseudomeatus and tragus.
Main Results:
The new method successfully eliminates skin grafting in ear reconstruction. Two tissue expanders provide sufficient skin for full coverage. The upper flap covers the anterior surface of the framework. The fascial flap wraps the framework from beneath. The lower flap covers the fascial flap’s raw surface. The pseudomeatus and tragus are formed in the final stage. This approach avoids donor site issues from skin grafts. The results suggest complete skin coverage without grafting.
Conclusions:
The authors propose that their method eliminates the need for skin grafting in auricular reconstruction. The use of two tissue expanders ensures adequate skin coverage. The three-stage process allows for precise framework placement. The fascial flap provides additional coverage without requiring grafts. The method reduces complications from skin shortages. The authors suggest this approach improves outcomes compared to conventional methods. The framework is anchored securely between expanded flaps. The results align with the goal of complete skin coverage without grafting.
The authors propose that this method improves outcomes by eliminating skin grafting and reducing complications.