Expanded Retroauricular Skin Flap and Mastoid Fascial Flap Method for Microtia Reconstruction : 800 Cases Report

Abstract Objective: The aim of this article is to report the application of expanding retroauricular skin fascia flap, and autogenous costal cartilage for congenital microtia reconstruction in 426 microtia cases. Methods: Microtia reconstruction was generally completed in 3 surgical stages procedure. In the first surgical stage, 50-80 ml kidney shaped tissue expander was inserted subcutaneously in retroauricular mastoid region. Inflation of saline volume increased up to 60-80ml and skin flap was expanded till 2-3 months postoperatively. In the second surgical stage, removal of tissue expander, formation of retroauricular skin flap, elevation of retroauricular fascia flap, and pedicles of both flap in remnant ear side were performed. Costal cartilage was harvested from ipsilateral side chest to the ear for reconstruction. 3-dimensional ear framework was sculpted with stabilization of structure, contour and erection. Simultaneously, intermediate full thickness skin graft of 4×8cm was obtained from previous incision site from where costal cartilage was harvested. Cartilage ear framework was anchored between skin flap and fascia flap, and fixed it symmetrically to the opposite normal ear, inferior portion of the ear framework was wrapped by remnant ear lobule, expanded skin flap covered the anterior portion of the framework, fascial flap was draped to the posterior side of framework and helical rim, then fascial flap was surfaced by intermediate full thickness skin graft. Suction drain was inserted and coated between skin flap and framework, drain was removed postoperative fifth day. Tragus construction and conchal excavation with skin graft were performed in third stage of microtia reconstruction. Results: Totally, 426 cases were diagnosed as unilateral microtia patients, 22 cases were bilateral microtia patients from October 2000 to October 2007. Therefore, 448 microtia ears were treated with tissue expander and autogenous costal cartilage. In 262 cases, structure of helix, tragus, conchal excavation, auriculocepahalic angle and symmetry to opposite normal ear were satisfied from followed up period 6 months to 4 years. Antihelix, triangular fossa and scapha were prominent with good result in most of the patients. Conclusions: Expanded retroauricular skin flap combines with fascial flap can cover the different size and height of cartilage ear framework in single surgical stage. At the same time, on the basis of structure stability and contour reality of cartilage framework, we can achieve fine structure and erect stability of constructed auricle. This method affords ideal result in microtia reconstruction. Keywords: Expanded retroauricular Skin and Fascial Flap, Congenital Microtia, Ear Reconstruction