Allogeneic Microtia Reconstruction as a Step in the Auricular Reconstructive Ladder: Personal Technique Using...

Microtia reconstruction remains one of the most technically demanding procedures in pediatric plastic surgery. Traditional autologous rib cartilage reconstruction is highly operator-dependent, time-intensive, and associated with donor-site morbidity. Although allogeneic cartilage has emerged as a viable alternative, framework fabrication remains challenging and dependent on carving expertise. This study describes the role of allogeneic auricular reconstruction as a potential first step within a proposed auricular reconstructive ladder. The author's technique using a novel interlocking, template-guided approach to auricular framework construction is presented to improve reproducibility and efficiency.

The author presents a standardized technique for stage I microtia reconstruction using frozen cadaveric rib cartilage in combination with an original set of 3-dimensional, interlocking carving templates designed in-house. The templates guide framework geometry, subunit proportionality, and cartilage selection while intentionally increasing scapha and triangular fossa width to accommodate soft tissue draping. Framework production is performed preoperatively, followed by implantation using established principles of auricular reconstruction.

Template-guided framework construction allowed consistent reproduction of auricular subunits. The interlocking design facilitated construct planning and assembly. Use of allogeneic cartilage eliminated donor-site morbidity and reduced operative time. The wider framework design facilitated skin coverage while preserving surface definition following healing.

The author presents a personal technique using novel 3-dimensional, interlocking templates for auricular framework construction as an efficient alternative to traditional manual carving. The use of allogeneic cartilage is proposed as an emerging option within the auricular reconstructive ladder, offering a biological reconstructive pathway for patients who decline donor-site morbidity associated with autologous rib harvest and the risks inherent to alloplastic reconstruction.