Ear reconstruction for microtia, or underdeveloped ears, remains a clinical challenge for plastic and reconstructive surgeons. The surgery requires not only a framework for the ear, but also adequate tissue for coverage of the construct. Traditional reconstruction has relied upon harvest of a segment of the patient's own cartilage to serve as the framework for such reconstruction. This technique has achieved further success with the addition of expansion, or stretching, of the skin posterior to the ear to provide coverage for the cartilage framework.

Dr. Wang and his colleagues from the Department of Plastic Surgery at the Second Affiliated Hospital of Kunming Medical University in Yunnan, China presented their ten-year experience with 166 ear reconstructions for microtia, published in the journal Plastic and Aesthetic Research. They performed their reconstructions in three stages: First, a 50-80 milliliter, kidney-shaped tissue expander was placed under the skin and soft tissues in the region behind the planned ear. A tissue expander is a balloon-like device which is gently filled with sterile fluid over a period of several months, thus allowing the tissue to be stretched. In this case, the expanders were filled to a total volume of 80-110 milliliters over a period of 3-5 months. Next, the expander was removed, and the cartilage framework was placed into this new space. The framework was created by harvesting normal cartilage from the 7th, 8th, and 9th ribs of the opposite side of the body, and then carving them in the shape of an ear. This complex was assembled with stainless steel wire prior to being placed into its new space. The final stage was performed 3-5 months later with rotation of the earlobe, removal of any excess tissue, and deepening of the bowl of the ear.

Some complications cited in the study included bleeding, exposure of the expander, exposure of the cartilage framework, infection with partial loss of the cartilage framework, wire exposure, and seroma (fluid collection). All complications were successfully treated.

Patients reported a high level of satisfaction with this technique, at 96.4%. They were followed for up to five years, and were questioned specifically about their satisfaction with the reconstructed ear's size, location, projection, convolution, skin-color match, and symmetry to the opposite ear.

The authors reviewed the studies of several other groups in their paper, noting the many advances that have been made since 1989 when tissue expansion behind the ear was first used by Dr. Yuiro Hata and his colleagues from the Department of Plastic Surgery at Kagawa Medical School in Japan. Various other methods for reconstruction have been attempted since that time, including the use of two expanders simultaneously, and overfilling a single expander. However, the authors noted that these techniques were associated with increased complication rates. For this reason, Dr. Wang and his co-authors developed a method in which the tissue is expanded less aggressively, but which nonetheless achieved a very high satisfaction rate.

Article: Full retroauricular skin and fascia expansion in microtia reconstruction: a single center experience of 166 cases, Ji-Hua Wang, Ting Tang, Yong-Jing He, Ying-Jia Zhang, Yun Yang, Plastic and Aesthetic Research, doi: 10.20517/2347-9264.2016.79, published 30 November 2016.