Microtia reconstruction using tissue expanders without skin grafts from groin region

Area of Science:

• Plastic Surgery
• Otolaryngology
• Regenerative Medicine

Background:

• Microtia reconstruction traditionally involves multistage procedures, often utilizing autogenous rib cartilage and requiring groin skin grafts for auricular elevation.
• Existing methods, including Nagata and Firmin's two-stage approach, have limitations in skin graft donor site morbidity.

Purpose of the Study:

• To present a novel, simplified three-stage surgical technique for microtia reconstruction.
• To evaluate the efficacy of using tissue expanders for auricular elevation, aiming to avoid groin scarring and improve aesthetic outcomes.

Main Methods:

• A three-stage surgical approach was employed: 1) rib-cartilage graft, 2) subcutaneous insertion and expansion (3-4 months) of a 45-ml rectangular tissue expander in the postauricular mastoid region, and 3) auricular elevation using the expanded skin flap.
• The expanded postauricular skin flap was advanced to create the auriculocephalic sulcus, with remnant skin reused for the reconstruction, thus obviating the need for groin skin grafts.

Main Results:

• The study treated 62 microtia cases between January 2011 and January 2014 using the described method.
• No major complications were reported, and satisfactory aesthetic results were achieved, characterized by fine structure, symmetry, appropriate auriculocephalic angle, and stable cartilage framework.

Conclusions:

• The presented technique offers a simple, reproducible method for microtia reconstruction using expanded skin, achieving excellent aesthetic results without the morbidity associated with groin donor sites.
• Despite an additional surgical step, patient satisfaction was significantly enhanced due to the elimination of groin scarring.