Stack-Up Technique to Create a Three-Dimensional Costal Cartilage Framework in Ear Reconstruction.

BACKGROUND: Ear reconstruction is one of the most challenging procedures for plastic surgeons. The costal cartilage is the most accepted material, and the framework fabrication methods also vary with the different ear reconstruction methods. This study aimed to present our clinical experience using a novel method for costal cartilage framework fabrication with the "fully expansion technique" ear reconstruction without a skin graft. From January 2017 to June 2018, 107 patients with unilateral microtia underwent ear reconstruction with the fully expansion technique. Costal cartilage was designed into different components and stacked up to form the multilayer structure and adequate projection. Preexpansion provided larger skin flap for fully cover the anterior and posterior parts of the framework. Then the anterior ear structures and the posterior sulcus, as well as the ideal bilateral symmetry, were established simultaneously without a skin graft. A total of 107 patients in this group were followed up for 8 to 24 month, and altogether 98 patients (91.6%) were satisfied with the reconstruction. The cartilage "stack-up" framework fabrication and fully expansion technique provided a well-defined, well-projected, and bilateral symmetrical reconstructed ear.