Two-Staged Microtia Reconstruction With Autologous Rib Cartilage: A 25-Year Experience.

It was already known that microtia presents a complex reconstructive challenge due to the intricate three-dimensional geometry of the human ear. Prior research has shown that autologous costal cartilage remains the preferred material for these frameworks because of its biocompatibility and durability. Surgeons must replicate more than a dozen distinct subunit structures to achieve a convincing aesthetic result. The difficulty of reproducing more than a dozen complicated subunit structures makes this one of the most demanding tasks in plastic surgery. Traditional methods for auricular repair often face hurdles in maintaining long-term projection and structural definition. Despite its advantages, the technical difficulty of carving costal segments into a realistic ear shape often leads to inconsistent outcomes. This absence of evidence motivated a comprehensive evaluation of a modified two-stage technique across a massive longitudinal cohort.

This longitudinal study assesses the surgical outcomes of 3000 auricular reconstructions performed over a twenty-five-year period. The investigators sought to validate a modified surgical protocol derived from the foundational Brent and Nagata methodologies. Their primary objective involved refining the fabrication of the auricular framework to ensure anatomical accuracy and structural longevity. The research team focused on tailoring incision designs and earlobe transposition techniques to the specific remnant tissue present in different microtia classifications. They aimed to quantify patient satisfaction levels and document the incidence of various postoperative complications. By analyzing data from 2000 to 2024, the authors intended to demonstrate the efficacy of their individualized approach to ear reconstruction.

The surgical team implemented a two-staged reconstruction process using autologous rib cartilage harvested from the sixth through eighth costal segments. In cases requiring additional volume, the ninth rib segment was also incorporated into the framework fabrication. During the first stage, surgeons performed earlobe transposition and created an individualized framework comprising the helix, antihelix, tragus, and antitragus. The second stage focused on auricular elevation, where the structure was supported by either a cartilage block or synthetic materials. To ensure adequate coverage, the elevated framework was wrapped in a superficial retroauricular fascia flap. A split-thickness skin graft (STSG) was then applied over the fascia to complete the external surface of the new ear. Patients underwent rigorous follow-up assessments ranging from six months to fifteen years to monitor for framework deformities or material exposure.

The analysis of 3000 cases showed that 86.7% of the patient population achieved high levels of satisfaction with their reconstructed ear contours. During the initial surgical stage, the researchers recorded 199 instances of complications, including hematoma, infection, and flap venous congestion. The second stage involved 277 cases of adverse outcomes such as skin necrosis, cartilage exposure, and the extrusion of steel wires. Some patients experienced the exposure of support materials or the development of hypertrophic scars following the elevation procedure. Framework deformities were also noted as a potential long-term complication in a subset of the cohort. Statistical tracking indicated that the modified technique maintained vividly detailed contours across the diverse patient group. The proper utilization of costal segments contributed to a cohesive framework characterized by harmonious proportions and natural features.

The authors conclude that their modified two-staged approach provides a robust framework for successful microtia reconstruction using autologous tissue. Utilizing costal cartilage allows for the creation of a durable and anatomically precise auricular structure that withstands the test of time. The study demonstrates that individualized surgical planning based on remnant tissue types significantly improves aesthetic outcomes. While complications such as skin necrosis or material exposure can occur, the overall incidence remains manageable within a large-scale clinical setting. This 25-year experience suggests that the integration of Brent and Nagata techniques offers a superior balance of detail and stability. Future clinical practice may benefit from these refined protocols to achieve more natural results in pediatric and adult microtia patients. The researchers emphasize that the longevity of the autologous framework is a key factor in long-term patient satisfaction.