Auricular Reconstruction of Congenital Microtia Using Autogenous Costal Cartilage: Report of 25 Cases

Abstract

Background: Total auricular reconstruction in congenital microtia is one of the most challenging problems faced by a reconstructive surgeon as it demands precise surgical technique combined with artistic creativity. Ear reconstruction requires carefully planned procedures.The use of autogenous rib cartilage is the gold standard for microtia reconstruction. Alternatives for auricular reconstruction include autologous costal cartilage graft, prosthetic reconstruction with osseointegrated implants or the use of alloplastic frameworks (e.g. porous polyethylene) Material & Methods: This is a prospective study. All the cases, which numbered about 25 cases, had been operated by the department of plastic surgery at Osmania General Hospital between August 2009 to May 2012.All our cases were underwent ear reconstruction using autogenous rib cartilage of contralateral side in three stages with 3-6 months of interval between each stage Stage I: Auricular framework fabrication with contralateral rib cartilage and insertion of cartilage in the skin pocket Stage II: Auricular framework elevation Stage III: Lobule transposition Results: The results of the reconstructed auricles in 25 patients were satisfactory in view of symmetry with opposite ear, lobule position, helical projection and creation of post-auricular sulcus with good aesthetic balance. The complications includes hair bearing are over the reconstructed pinna in 8 patients, infection with cartilage exposure in one patient, surgical emphysema of donor area in one patient. Conclusion: Although various donor sites have been used for harvesting the cartilage, only costal cartilage provides a substantial source for fabricating total ear framework. The cosmetic outcome and least complication results in our series support this conclusion.This method of auricular reconstruction is a sound tested procedure that may be done optimally in three stages, using techniques that are within the competence of the trained plastic surgeon.