Full retroauricular skin and fascia expansion in microtia reconstruction: a single center experience of 166 cases

Aim: Ear reconstruction is a challenge for plastic and reconstructive surgeons. The ear requires sufficient skin coverage and a three-dimensional (3D) cartilage framework. In this paper, the authors present their 10-year experience in microtia reconstruction using tissue expansion and an autogenous rib cartilage framework. Methods: Ear reconstruction was performed in 3 operative stages. During the first procedure, a 50-80 mL kidney or cylinder-shaped expander was implanted deep to the subcutaneous fascia of the retroauricular mastoid region. Over a period of 3-5 months, the expander was filled to a final volume of 80-110 mL. In the next operation, the retroauricular fascia was eliminated or reserved following expander removal, and the autogenous costal cartilage framework was placed below the expanded skin flap. At the third and final stage, the earlobe transposition, tragus construction and conchal deepening were performed. Results: A total of 165 patients (166 ears) were reconstructed using tissue expansion and an autogenous rib cartilage framework. Complications included hematomas in 3 cases, expander exposure in 8 cases, cartilage exposure in 6 cases, infection and cartilage resorption in 2 cases, exposure of steel wire in 4 cases, and aseptic seroma in 2 cases. Follow-up ranging from 3 months to 5 years showed that 159 patients were satisfied with the reconstructed ear including size, location, projection, convolution, skin-colour matching, symmetry with opposite ear. Conclusion: Expansion of the retroauricular skin and fascia can provide sufficient non-hair-bearing skin and tissue for coverage of a three-dimensional costal cartilage framework. Avoidance and prompt treatment of complications are advised in order to obtain a satisfactory reconstruction of the ear.