Aesthetic Auricular Reconstruction in Adult Patients with Rib Cartilage Calcification Using a Modified Two-Step Technique

Background: It is very important for congenital microtia patients to achieve better aesthetic appearance, craniofacial balance and mental health through auricular reconstruction. But there are great challenges for plastic surgeons on how to perform this technique in adult patients with tough and rigid rib cartilage because of the different extent of calcification. To lower the harvest of the cartilage and reduce the suffering during the operation, in this study, we report a modified two-step method for adult patients who suffered rib cartilage calcification in auricular reconstruction. Methods: From January 2012 to January 2018, 89 adult patients (aged from 24 to 50) with cartilage calcification were enrolled and received auricular reconstruction using the modified two-step technique. The whole procedure was performed in two surgical stages. In the first stage, rib cartilages were harvested and modified cartilage frameworks were designed, fabricated and grafted, which included an ear-shaped framework and a C-shaped base part. The ear-shaped framework was inserted into the mastoid region through a W-shaped incision, but the C-shaped base part was embedded subcutaneously in the donor site. In the second stage, the C-shaped base part was transplanted into the mastoid region to elevate the reconstructed ear. A retro-auricular fascia flap and a free skin graft were used to cover the posterior side of the reconstructed ear. Results: The patients were followed for 6 to 24 months. During the follow-up visiting, 80 cases (89%) were satisfied with the outcomes in size, shape, location and details of reconstructed ears. Conclusion: Our modified technique is safe and effective for auricular reconstruction, reduces the harvest of cartilage and decreases the suffering as well in adult patients with congenital microtia and rib cartilage calcification. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.