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Plastic & Reconstructive Surgery:
doi: 10.1097/01.prs.0000436828.80947.69
Pediatric/Craniofacial: Original Articles

Correction of Lobule-Type Microtia: I. The First Stage of Costal Cartilage Grafting

Yotsuyanagi, Takatoshi M.D., Ph.D.; Yamashita, Ken M.D.; Yamauchi, Makoto M.D., Ph.D.; Sugai, Asuka M.D.; Kayama, Musashi M.D.; Gonda, Ayako M.D.; Kita, Arisa M.D.

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Abstract

Background: Recently, auriculoplasty with costal cartilage grafting has been successfully used for correcting microtia and creating a clearly refined contour and a natural appearance of the ear. However, several important problems remain unsolved in these techniques. The authors describe an improved technique for harvesting costal cartilage with minimal morbidity and a new procedure for fabricating a cartilage frame that ensures a refined shape and rigid structure of the constructed ear.

Methods: Costal cartilage is harvested directly with a chisel. This technique enables some of the cartilage at the chest wall to remain intact. The base frame is fabricated by two cartilage blocks partly overlapped on the area of the antihelix. The thickness in the overlapping area emphasizes the contour between the antihelix and the helical crus. To prevent absorption of the cartilage, helical and antihelical parts are created using the outer rigid layer of the harvested cartilage and are covered as much as possible by perichondrium.

Results: A total of 137 ears in 121 patients were corrected with the authors’ technique and followed up for at least 3 years. Almost all of the patients could walk within 2 days after the operation. The structure and contour of the constructed ear were well maintained.

Conclusions: Attention should be given not only to successful outcomes of construction of the ear but also to minimal morbidity for the patients. Our technique made it possible to construct a cosmetically refined ear that could be maintained for a long period and minimize the pain and deformity of the donor’s chest.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

©2014American Society of Plastic Surgeons

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