Tactile Sensitivity After Ear Reconstruction with Tissue Expansion: A Semmes-Weinstein Monofilament Study

Protective sensation is crucial to avoid injury in the reconstructed auricle. This study aimed to objectively quantify cutaneous sensitivity following autologous ear reconstruction using tissue expansion for unilateral microtia compared to the sensation of healthy auricles.

In this retrospective study, participants who underwent autologous auricular reconstruction with tissue expansion and were at least 6 months post-operation were included. From January 2025 to June 2025, standardized sensory testing with Semmes-Weinstein monofilaments (SWM) was performed at 12 predefined anatomical points on both the reconstructed and unaffected ears.

A total of 42 patients were included. At six months post-operation, cutaneous pressure thresholds were significantly higher at 9 of the 12 tested points on the reconstructed auricle compared to the unaffected side (P < 0.005), except for the lobule, tragus, and concha. The highest threshold was at the apical helix (4.42 ± 3.57 g/mm², P < 0.001). Other points showed progressively lower increases: posterior helix (2.64 ± 2.81 g/mm², P < 0.001), antihelix (2.02 ± 3.44 g/mm², P < 0.001), triangular fossa (1.84 ± 3.11 g/mm², P = 0.001), inferior helix (1.17 ± 1.71 g/mm², P < 0.001), scaphoid fossa (0.87 ± 1.18 g/mm², P = 0.018), helix crus (0.79 ± 1.39 g/mm², P = 0.001), superior third of the postauricular sulcus (0.64 ± 1.21 g/mm², P = 0.003), and inferior third of the postauricular sulcus (0.48 ± 1.04 g/mm², P = 0.007). All patients and families were satisfied with the outcome of auricular reconstruction.

Compared to the healthy auricles, cutaneous hypoesthesia persists after autologous auricular reconstruction with tissue expansion at most anatomical subsites, particularly at the superior helix. Patients and families should be informed of this potential risk of cutaneous sensitivity hypoesthesia and protective measures for the superior helix are recommended.

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