Use of Allogeneic Rib Cartilage for Microtia Repair: Preliminary Data on a Single Institutional Experience

Microtia is a congenital deformity frequently requiring surgical reconstruction for functional and psychosocial deficits. Autologous costal cartilage remains the gold standard due to its mechanical reliability, but concerns regarding donor site morbidity, pneumothorax, and graft resorption have prompted investigation into alternative graft sources. This study evaluates early outcomes using allogeneic (cadaveric) costal cartilage in microtia reconstruction at Nemours Children's Health Hospitals. Ten patients (9 male, 1 female) underwent 2-stage auricular reconstruction between August 2022 and January 2025. Eight patients received allogeneic cartilage, and 2 underwent autologous reconstruction. All procedures followed standard protocols with individualized cartilage carving strategies. Patients were followed for an average of 21.5 months (range, 7-36 mo). Resorption was observed exclusively in the allogeneic group (4/8 patients) but was limited and did not compromise aesthetic outcomes. No statistically significant association was identified between reconstruction type and complication rate (P=1.00), swelling (P=0.378), or infection. Wire extrusion and dehiscence occurred in only 1 allogeneic case each. Statistical analyses revealed weak to moderate associations between allogeneic cartilage use and resorption (phi=0.4082) and between resorption and wire extrusion (phi=0.4082), though findings were limited by small sample size. Carving extent and style did not demonstrate consistent correlation with resorption. This early experience suggests that allogeneic cartilage is a viable alternative for auricular reconstruction, offering reduced operative time and eliminating donor site morbidity. While a trend toward limited resorption in allogeneic constructs was noted, larger studies are needed to confirm long-term efficacy.