Secondary Ear Reconstruction Using The Existing Tissue Envelope

Background and Purpose:  Reconstruction of the external auricle remains a challenge to plastic surgeons. Correction of failed ear reconstruction is difficult at best. Since Tanzer presented his reliable technique for ear reconstruction with autogenous costal cartilage, many have published variations of his technique for primary ear reconstruction with impressive results. Occasionally revisions are required. Limited discussion is found in the literature regarding techniques for secondary reconstruction^1-3. We present six cases of secondary ear reconstruction using a newly carved autogenous costal cartilage framework and the existing tissue envelope.

Methods:  A review was conducted of six cases of secondary reconstruction of the external auricle. Each patient underwent removal of the original framework and replacement with a newly sculpted autogenous costal cartilage framework at the same operation.  In each case, the new framework was placed within the existing tissue envelope. The patients were evaluated for complications and aesthetic quality. Aesthetic quality was evaluated comparing photographs and plaster castings of the ears.

Results: Of the six patients, three were female and three were male. The age range was 7-35 years. Time to follow-up was 2-29 months.  One patient originally had a porous polyethylene implant while the other five had frameworks constructed with autogenous cartilage. The polyethylene implant was removed due to chronic infection and drainage. The second framework was removed due to extruding surgical wire with associated infections. The other frameworks were removed due to deformity. All ears were reconstructed with newly constructed autogenous costal cartilage frameworks. Postoperatively, there were no infections. One ear developed partial necrosis of the original postauricular skin graft requiring another procedure for closure.  All six ears have maintained good size, contour, and appearance.

Conclusions:  Secondary ear reconstruction from prior failed surgery is a daunting challenge. This article reports six successful cases. Despite the small number in this series, we demonstrate that secondary reconstruction, using the existing tissue envelope and newly sculpted autogenous costal cartilage, can be achieved with improvement. Proper patient selection and skin quality is paramount to obtain an optimal outcome. We anticipate that additional cases will support the reliability of the technique.