A 20-year experience with the Brent technique of auricular reconstruction: pearls and pitfalls.

BACKGROUND: The surgical treatment of 291 patients with auricular deformities is reported. This series includes correction of acquired defects in 15 patients and congenital malformations in the remaining 276. In the latter group, 222 had unilateral microtia, 38 had bilateral microtia, and 16 deformities were attributable to failed reconstructions.
METHODS: Technical details are given on the planning and executing of operations, including the following: positioning of the reconstructed ear; unconventional lobule transposition for selected patients with facial microsomia; costal cartilage harvesting; framework construction with absorbable sutures; tragus and auricular sulcus construction; and secondary reconstructions with temporal fascial flaps, radical framework revision using the same skin pocket, and total reconstructions with costal cartilage grafts using the original skin envelope.
RESULTS: A total of 326 ears were reconstructed in 291 patients using autogenous costal cartilage: 222 in unilaterally affected microtia patients, 73 in 38 bilaterally affected microtia patients, 16 secondary reconstructions of microtia patients, and 15 in acquired deformities. Two hundred sixty-four of the 291 patients (90.7 percent) were examined at least 1 year after completing treatment. In the remaining 27 patients (9.3 percent), follow-up was not possible for several reasons. Surgery-related complications (hematoma, skin loss, and infection) totaled 1.9 percent. Hypertrophic scars and keloids with important aesthetic consequences were 5.3 percent.
CONCLUSIONS: Consistently good results were associated with progressive experience and favorable conditions (i.e., isolated type II or III microtia, appropriate amount and quality of costal cartilage, and thin and elastic auricular skin). Recognizing unfavorable conditions helped with sound preoperative planning and discussion of expectations with patients and families.