[Refined surgical protocol and clinical efficacy of total expansion auricular reconstruction surgery]

Objective: To summarize the refined surgical protocol and clinical efficacy of total expansion auricular reconstruction surgery. Methods: This study was a retrospective study of case series. From July 2015 to June 2025, 1 136 patients (1 187 ears) with congenital microtia who met the inclusion criteria were admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Air Force Medical University, including 781 males and 355 females, aged 8-40 years. All the patients underwent total expansion auricular reconstruction surgery, a procedure performed in 3 stages, with stage Ⅰ involving skin and soft tissue expander implantation, stage Ⅱ involving costal cartilage harvesting and expanded flap and residual ear management, cartilage framework fabrication and implantation, and stage Ⅲ involving residual ear revision and earlobe transposition. The postoperative complications after stages Ⅰ, Ⅱ, and Ⅲ were observed and recorded, and the total complication rate was calculated. At the last follow-up, patients' satisfaction with the surgical outcome was surveyed using a self-designed satisfaction scale, and the satisfaction rate was calculated. Results: Postoperative hematoma occurred in 33 patients, including 17 cases after the stage Ⅰ surgery, 15 cases after the stage Ⅱ surgery, and 1 case after both the stage Ⅰ and Ⅱ surgeries. Cartilage framework infection occurred in 15 patients after the stage Ⅱ surgery, cartilage framework helix fracture occurred in 3 patients after the stage Ⅱ surgery, and cartilage framework deformation occurred in 12 patients after the stage Ⅱ surgery. The total complication rate of patients was 5.5% (63/1 136). At the last follow-up during 3 months to 4 years after the stage Ⅲ surgery, 957 patients were satisfied with the surgical outcome, 156 patients were basically satisfied, and 23 patients were dissatisfied, with satisfaction rate of 98.0% (1 113/1 136). Conclusions: Total expansion auricular reconstruction surgery for congenital microtia provides sufficient expanded skin tissue, eliminating the need for skin grafting. The reconstructed auricle achieves an excellent shape with few complications, and patients are highly satisfied with the surgical outcome.