Reconstruction of microtia. Pursuing a natural appearance.

We have designed a "contour-accentuated" auricular framework in which the depth and height of the relief of the contours have been exaggerated to improve the illusion of three-dimensional topography. In one technique, the "full framework," a large amount of supplemental skin coverage is needed, and this is provided by a superficial temporal artery flap surfaced with postauricular skin and groin skin. In the second type, the "low-profile framework," the supplemental skin graft requirement is less and is provided by local subcutaneous tissue flaps in the conchal-tragal area. These are surfaced with postauricular skin. These steps have improved our ability to provide a three-dimensional quality to ear reconstruction in microtia.