Microtia Reconstruction in Hemifacial Microsomia Patients: Three Framework Coverage Techniques

Background: Microtia with hemifacial microsomia is difficult to treat because of skin volume deficiency. To provide further information for coverage techniques in microtia reconstruction, the authors have reviewed and analyzed patients who underwent surgery at their center. Methods: A total 52 patients with microtia with hemifacial microsomia who underwent reconstruction between 2006 and 2016 were involved. Patients were reviewed retrospectively by examining medical records and photographic data. Results: All reconstructed cases were followed for 6 months to 10 years (median, 33 months). The average (median) surgeon’s satisfaction score was 8.2 (median, 9) for the embedded and elevation technique ( n = 23); 7.89 (median, 8) for the temporoparietal fascia flap technique ( n = 10); and 6.30 (median, 7) for the subfascial expansion technique ( n = 19). The median score difference between the embedding and subfascial expansion techniques was statistically significant ( p = 0.03). Major factors that deteriorated aesthetic outcomes were large reconstructed ears (11 cases), cartilage framework resorption (11 cases), mismatched skin color (eight cases), different axis (seven cases), and different shapes (five cases). Mismatched skin color was significant in cases treated with the fascia flap technique ( p < 0.0001), whereas cartilage framework resorption was significant in cases treated with the tissue expansion technique ( p = 0.004). Conclusions: To obtain better aesthetic outcomes, the embedding technique should be used when the patient shows a mild to moderate degree of low hairline and usable remnant vestiges. In cases showing severe degrees of associated anomalies, the temporoparietal fascia flap technique should be used. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.