BACKGROUND: The authors propose here a new strategy to obtain exceedingly expanded retroauricular mastoid skin for sufficient coverage of the three-dimensional autogenous costal cartilage framework generally used in auricular reconstruction surgery. From February 2000 to September 2009, 42 microtia reconstructions were performed using this new strategy. METHODS: Auricular reconstruction was performed in three surgical stages. In the first stage, a 50-ml kidney-shaped expander was inserted subcutaneously in the retroauricular mastoid region. From 5 to 8 ml saline was then injected into the expander every 4 days until the final volume of the expander reached 100-120 ml. In the second stage, we divided the expanded mastoid skin into a superior two-third region (flap A) and an inferior one-third region (flap B, rotation flap). Autogenous costal cartilage framework was then enveloped by these expanded flaps. Tragus construction and conchal excavation was performed in the third stage. RESULTS: All patients were followed up from 6 months to 4 years after reconstruction. A total of 36 cases reported to be satisfied with the appearance of good shape, accurate size, right orientation, and duplication of well-detailed structures. Further revision was requested by six of the total. Complications in this series includes one case of haematoma, two cases of partial evection of the expanded skin and two cases of partial skin necrosis of the helix. All the complications were treated appropriately. CONCLUSION: Exceeding expansion can provide sufficient retroauricular non-hair-bearing skin tissues for draping the auricular cartilage framework. Skin grafts and retroauricular fascial flap are not needed any more. Patients are usually satisfied with their reconstructive auricles as regards the size, location, projection, convolution, skin-colour matching, etc. Exceedingly expanded retroauricular flaps are the appropriate envelope for the auricular cartilage framework.
BACKGROUND: The authors propose here a new strategy to obtain exceedingly expanded retroauricular mastoid skin for sufficient coverage of the three-dimensional autogenous costal cartilage framework generally used in auricular reconstruction surgery. From February 2000 to September 2009, 42 microtia reconstructions were performed using this new strategy. METHODS: Auricular reconstruction was performed in three surgical stages. In the first stage, a 50-ml kidney-shaped expander was inserted subcutaneously in the retroauricular mastoid region. From 5 to 8 ml saline was then injected into the expander every 4 days until the final volume of the expander reached 100-120 ml. In the second stage, we divided the expanded mastoid skin into a superior two-third region (flap A) and an inferior one-third region (flap B, rotation flap). Autogenous costal cartilage framework was then enveloped by these expanded flaps. Tragus construction and conchal excavation was performed in the third stage. RESULTS: All patients were followed up from 6 months to 4 years after reconstruction. A total of 36 cases reported to be satisfied with the appearance of good shape, accurate size, right orientation, and duplication of well-detailed structures. Further revision was requested by six of the total. Complications in this series includes one case of haematoma, two cases of partial evection of the expanded skin and two cases of partial skin necrosis of the helix. All the complications were treated appropriately. CONCLUSION: Exceeding expansion can provide sufficient retroauricular non-hair-bearing skin tissues for draping the auricular cartilage framework. Skin grafts and retroauricular fascial flap are not needed any more. Patients are usually satisfied with their reconstructive auricles as regards the size, location, projection, convolution, skin-colour matching, etc. Exceedingly expanded retroauricular flaps are the appropriate envelope for the auricular cartilage framework.