Secondary revisions due to unfavourable results after microtia reconstruction

Summary 

Autologous rib cartilage grafting is a basic modality in auricular reconstruction, especially in cases of congenital microtia. However, due to heavy scarring at operative sites, lack of healthy normal tissues and an unfavourable blood circulation status, revision auricular reconstruction has always presented a surgical challenge to reconstructive surgeons.

Rib cartilage grafts were used for revision auricular reconstruction in six cases. In all six, previous attempts at auricular reconstruction had failed due to graft or implant infection. Four cases had previously undergone a rib cartilage graft, one Medpor^® implantation and another osseo-integrated prosthesis implantation. In total, 16 operations were performed on the six cases. Minor complications were noted after two operations, but no major complications, including infections, occurred. All patients were satisfied with their results.

Our findings suggest that autologous rib cartilage grafts should be considered for revision auricular reconstructions. Furthermore, tissue expander surgery or the re-use of previously grafted skin may be required to overcome the limitations of revision surgery. However, when meticulously performed, auricular reconstruction with a rib cartilage graft can produce reliable aesthetic results with minimal complications.

Keywords: Microtia, Auricular reconstruction, Rib cartilage graft, Secondary revision