Microtia Reconstruction: Our Strategies to Improve the Outcomes

Area of Science:

• Plastic Surgery
• Otolaryngology
• Regenerative Medicine

Background:

• Autologous costal cartilage framework is the standard for microtia reconstruction.
• Established Nagata principles guide auricular reconstruction.
• Author's modifications aim for stable, long-term auricular reconstruction outcomes.

Purpose of the Study:

• To present author-developed modifications for microtia reconstruction.
• To discuss technical details for stable, long-term auricular reconstruction.
• To evaluate the influence of specific changes on reconstruction outcomes.

Main Methods:

• Retrospective review of microtia reconstructions (2015-2021).
• Inclusion criteria: primary reconstruction, minimum 6-month follow-up with photos.
• Exclusion criteria: secondary reconstruction, <6-month follow-up.
• Outcomes assessed for appearance and durability.
• Influence of age at reconstruction and material choices evaluated.

Main Results:

• Reconstruction at <15 years yielded good outcomes in 9% (1/11 ears).
• Reconstruction at >15 years yielded good outcomes in 53% (9/17 ears).
• Infections and wire extrusion correlated with cartilage resorption.

Conclusions:

• Delaying reconstruction to 15+ years improves outcomes.
• Utilizing double-armed nylon sutures and adjusting framework projection enhances results.
• Second-stage reconstruction may be avoidable based on patient satisfaction with initial projection.