Management of Acute Postoperative Infections Following Microtia Reconstruction With Costal Cartilage Grafts

Acute postoperative infection is a serious complication of microtia. This study analyzes infection rates and treatment outcomes to identify risk factors and improve infection control strategies.

We reviewed data from June 2014 to May 2024 for 630 ears (577 patients) that underwent costal cartilage grafting and 573 ears (527 patients) that underwent ear elevation. The primary endpoint was infection onset within 1 month after surgery and clinical outcome. Secondary endpoints included remnant cartilage classification, hairline position, case type (primary versus secondary cases), medical history and comorbidities, operative time, length of hospital stay, hematoma or local wound complications, and the method of cartilage framework fixation. In addition, the timing, causative organisms, and management of infections were investigated.

Infection and cartilage framework removal rates were significantly higher in the costal cartilage grafting group. Univariate and multivariate analyses revealed that hematoma, secondary cases, and local wound complications were independent risk factors for postoperative infection in the costal cartilage grafting group. Early aggressive irrigation and debridement allowed preservation of the cartilage framework, and approximately 58% of these cases maintained an auricular contour comparable to that before infection.

Hematoma, secondary cases, and local wound complications were independent risk factors for acute infection after costal cartilage grafting. Surgical procedures focusing on hematoma prevention and adequate flap perfusion are important to reduce infection risk. Early surgical intervention with systemic antibiotics in the initial phase of infection may help preserve the grafted cartilage and achieve successful auricular reconstruction.