Bilateral autologous microtia reconstruction: a simultaneous two-stage approach

Abstract

Traditionally, for cases of bilateral autologous ear reconstruction, each side is addressed independently in discrete operative sessions. Herein, we describe our approach to bilateral microtia reconstruction, where each stage is performed simultaneously on both sides. All patients who underwent autologous ear reconstruction by a single surgeon (NWB) from April 2006 to January 2012 were retrospectively reviewed. Reconstruction was realized as a two-stage procedure, with each stage performed simultaneously on both sides in bilateral cases. Patient demographics, operative details and incidences of peri- and post-operative complications were collected. A cost comparison of two-stage versus four-stage bilateral auricular reconstruction was completed. Among a total of 182 patients who underwent autologous ear reconstruction, 18 patients (male, 10, median age, 11.4 years) had simultaneous bilateral auricular correction. Based on estimates derived from unilateral reconstruction theatre times, simultaneous bilateral reconstruction resulted in a savings of 56 min for the first stage and 97 min for the second stage of reconstruction. Moreover, surgical times decreased as operative experience with auricular reconstruction was accrued. There was no increased incidence of peri- or post-operative complications noted. Based on cost estimates at our institution, bilateral reconstruction as a two-stage procedure resulted in a health care cost savings of £10448.16 ($16790.72 USD) per patient with bilateral microtia. Simultaneous bilateral autologous ear reconstruction is a practicable cost-effective treatment strategy with notable aesthetic and personal benefit to the patient with no increased morbidity. Level of Evidence Level III, therapeutic study.