Single-Stage Microtia Reconstruction: Avoiding Implant Exposure Via Intraoperative Angiography, A Cutting-Edge...

Microtia is defined as the congenital underdevelopment of the pinna. Microtia repair has been described as one of the most challenging reconstructive operations. Novel developments such as intraoperative Indocyanine green (ICG) angiography can assist surgeons in visualizing vascular structures critical to achieving complication-free results.

A retrospective cohort review of a single team's total alloplastic auricular reconstruction cases was conducted to analyze the impact of ICG on the rate of complications requiring unplanned revision surgery. Variables analyzed included patient demographics, microtia grade, laterality, ICG utilization, and surgical complications.

Seventy-one consecutive ears were included for final analysis; 21 (29.6%) ears were reconstructed with the assistance of ICG angiography. Among all included ears, the mean age was 8.9 years (range: 4.3-18.3 y), 31 (44%) were female, 50 (70%) were grade 3 and 43 (61%) were right-sided. The ears reconstructed with intraoperative ICG angiography had zero auricular framework exposures compared with 6 (12%) in those reconstructed without ICG (P=0.1). All but one exposure was salvaged successfully through secondary procedures. No adverse events related to ICG angiography were observed.

Microtia reconstruction surgery continues to evolve and demand a meticulous approach. This study suggests that the use of intraoperative ICG angiography has assisted in securing adequate vascular supply, leading to improved surgical results.