Modification of two-flap method and framework construction for reconstruction of atypical congenital auricular deformities.

A single-stage two-flap method utilizing an anteriorly based subcutaneous pedicled skin flap and a mastoid fascial flap has been applied successfully for reconstruction of lobule-type microtia. This paper presents three modifications of the two-flap method, with which atypical congenital auricular deformities necessitating both framework construction and coverage were reconstructed successfully. In middle and upper auricular deformities such as a concha-type or a scapha-type microtia, a cranially based postauricular skin flap and lower mastoid fascial flap were used. For upper auricular deformities such as microtia representing lop-ear deformity, a narrow cranially based postauricular skin flap (Grotting flap) and upper mastoid fascial flap were used. For lower auricular deformities such as total absence of the earlobe, a cranially based skin flap and lower mastoid fascial flap were utilized. In each deformity the framework was totally or partially constructed with autogenous costal, conchal, or septal cartilage or their combination according to the size or shape of the defect. Fifty-two atypical auricular deformities were corrected with the modified two-flap method and framework construction. The follow-up has ranged from 4 months to 3 years (average 18 months). No major surgical complications occurred in this series. Representative cases reconstructed with each modified method are shown. While the shape of the cartilage framework is sculptured according to the type and degree of deformity in each patient, the modified two-flap method not only adequately covers the cartilage but also preserves the fabricated framework in its natural contour and position in the diverse varieties of atypical congenital auricular deformities.