Two-Staged Microtia Reconstruction With Autologous Rib Cartilage: A 25-Year Experience

Objectives: Microtia reconstruction with autologous rib cartilage remains one of the most challenging works because reproducing more than a dozen complicated subunit structures is difficult. The authors report 3000 autologous cartilage auricular reconstructions in different types of microtia between 2000 and 2024. Methods: The surgical technique was modified from the Brent and Nagata methods. At the first stage, incision design and earlobe transposition were performed according to different types and remnant tissue. Individualized helix, antihelix, tragus, antitragus, and base frame were fabricated from the sixth to eighth costal cartilage, together with the ninth one if necessary. In the second stage, the auricle was elevated and supported by the cartilage block or artificial material and covered with a superficial retroauricular fascia flap and split-thickness skin graft. Results: The patients were followed up from 6 months to 15 years. Nearly 86.7% of them were satisfied with the final outline of the reconstructed ears. Complications such as hematoma, infection, flap venous congestion, skin necrosis and cartilage exposure, extrusion of the steel wires, exposure of support materials, hypertrophic scar, and framework deformities occurred in 199 (the first stage) and 277 cases (the second stage), respectively. Conclusions: The proper utilization of costal cartilage contributes to a cohesive framework with harmonious proportions. The authors’ approach helps obtain a vividly detailed contour of the auricle with natural features and low complications.