[Auricular reconstruction by soft tissue expansion techniques without skin grafting]

Current auricular reconstruction methods often rely on skin grafting, which can lead to visible scarring and additional donor site complications. While prior research has shown that tissue expansion can reduce the need for grafts, the specific application of dual-flap techniques in microtia remains underexplored. This gap motivated the investigation of whether expanded skin alone could fully cover reconstructed auricles without grafting. No prior work had resolved whether tissue expanders of varying volumes could reliably produce sufficient skin for auricular reconstruction. Existing studies have focused on single-flap expansions, but this paper introduces a dual-flap approach. The goal is to determine if this method can reduce grafting and minimize donor site scarring. Previous techniques have not addressed the full coverage of both front and back surfaces of the reconstructed framework. This study aims to fill that knowledge gap by testing a novel surgical approach.

The study aimed to evaluate a new auricular reconstruction technique that avoids skin grafting by using soft tissue expansion. The specific problem addressed is the need for a less invasive and more aesthetically favorable method for microtia patients. The motivation stems from the limitations of current skin grafting techniques, which can result in donor site scarring and complications. The researchers proposed that expanded skin could fully cover the reconstructed ear framework. The method involves using two tissue expanders to generate sufficient skin for both front and back surfaces. The study sought to determine if this approach could eliminate the need for grafting in patients with different grades of microtia. The goal was to assess cosmetic outcomes and complication rates. This approach could potentially reduce donor site scarring and improve patient satisfaction.

The study involved 31 patients with microtia undergoing auricular reconstruction. Tissue expanders of varying volumes were implanted under the mastoid skin. Patients with grade II or III microtia received two expanders (50 ml and 70 ml), while those with grade I microtia received one larger expander (100 ml). After expansion, the expanders were removed, and either autologous rib cartilage or Medpor scaffolds were implanted. The superior expanded flap was used to cover the front and upper back surfaces of the framework. The inferior flap was transplanted to cover the lower back surface. The remaining flap was used to cover the lateral head wound. No skin grafting was performed in any case. The surgical outcomes were evaluated based on cosmetic results and complication rates.

The study reported a 90% patient satisfaction rate (28 out of 31 cases). No skin grafting was required in any patient. A single case experienced epidermis blistering at the distal flap edge. No other complications were observed. The reconstructed ears underwent a second-stage operation after a follow-up of 6 to 12 months (mean 10.9 months). Cosmetic results were described as good. The donor site scar size averaged 5.2 ± 0.6 cm². The expanded skin was sufficient to cover both the front and back surfaces of the reconstructed framework. These findings suggest that the dual-flap expansion method can effectively replace skin grafting in auricular reconstruction.

The authors concluded that the new method of auricular reconstruction using soft tissue expansion is sufficient to cover the reconstructed framework without skin grafting. The technique leaves fewer complications and donor site scars. The results suggest that this approach is a viable alternative to traditional grafting methods. The study supports the use of tissue expansion as a reliable method for auricular reconstruction. The findings align with the authors' hypothesis that expanded skin can fully cover the reconstructed ear. The method was found to be effective across different grades of microtia. The authors propose that this technique can improve patient outcomes and reduce the need for additional donor sites. These conclusions are based on the observed cosmetic results and low complication rates.