Editorial| Volume 75, ISSUE 2, P509-510, February 2022

Celebrating the life of Satoru Nagata, MD, a microtia pioneer, 1950-2022

      Satoru Nagata, MD revolutionized total auricular construction for microtia with a combination of his artistic flair, quiet modesty, original thinking, uncompromising drive for perfection in his surgical approach and utter dedication to the care of his patients. It is a great loss to us all that he died on 2nd January suffering a heart attack aged 71.
      Fig 1
      Fig 1Dr Nagata having a deserved pause during an ear reconstruction.
      Dr. Nagata was born in 1950 in Nagasaki, Japan and as a boy of 11 years old, he first heard the story of the “atomic bomb maidens,” the young women who suffered severe burns on their faces and other parts of their bodies as a result of the bombs dropped on Hiroshima and Nagasaki in 1945. As a result of these disfigurements and because there was no effective treatment for these wounds in Japan at the time many of the young women committed suicide. At a young age he had shown great artistic promise and was considering art school but Dr. Nagata decided to become a reconstructive surgeon having been touched by the story of these women.
      Fig 2
      Fig 2The gathering of the ear reconstruction greats at the Edinburgh Ear Reconstruction Congress including (left to right) Chul Park, Moshe Kon, Saturo Nagata, Francoise Firmin, Burt Brent and David Gault.
      Dr. Nagata graduated from Tottori University School of Medicine in 1978 and began his plastic surgery residency at the University of Tokyo the following year. This was an era of great innovation in plastic surgery and at the time in Japan surgeons such as Kiyonori Harii, MD, of University of Tokyo, performed the world's first successful microvascular free flap transfer in September 1972 and the first free gracillis flap for facial reanimation in 1976 at Tokyo Metropolitan Police Hospital. Dr. Nagata contributed to Dr. Harii's work by filming his procedures and using his artistic skills in drawing all the surgical illustrations for Dr. Harii's Free Flap Atlas.
      Fig 3
      Fig 3Dr Nagata and team performing ear reconstruction.
      The chief of plastic surgery at University of Tokyo, Osamu Fukuda, MD, who visited Radford Tanzer, MD, of New Hampshire, went on to perform over 1,000 cases of autogenous microtia construction with the Tanzer method. While assisting Dr. Fukuda, Dr. Nagata was introduced to auricular construction and soon demonstrated his skillset in tragus reconstruction. Ever the perfectionist, he noticed the shallow concha cavity that resulted from this approach and dissatisfied with this he began to consider how he could obtain more skin to make the concha deeper and more natural in appearance. He lived in the Tokyo suburbs, and he commuted on a notoriously crowded train every day of a one-hour journey inbound and outbound. During one commute, he observed another passenger's ear and realised that redundant skin at the back of the ear could be used to make a deeper concha, the genesis of the lobule split technique.
      Dr. Nagata's observation and desire to improve surgical outcomes led to the changes in surgical approach and refinement in framework carving. He modified what he had learnt to the split lobule rotation technique resulting in more skin surface that could be transposed leading to a deeper concha bowl. He transformed the process of the costal cartilage carving and building the ‘3-D framework’ that made the results more defined and stable. These changes also led to a reduction in the number of stages required from the four-to-six procedures to only requiring two stages. He published six key articles about his new microtia surgery methods in PRS in 1993 and 1994, again beautifully illustrating each article himself.
      He was a passionate teacher accepting many surgeons from around the world to visit and learn from him, many going on to become respected practitioners in this field. Dr. Nagata's international reputation grew and he began to travel delivering lectures and surgical demonstrations all over the world. In 2005, he founded the Nagata Microtia Clinic in Toda-City, Saitama, a suburb of Tokyo, which attracted patients and plastic surgeons interested in his techniques from around the world. Dr. Nagata's passion for education never ceased, nor did his commitment to patients. During his life he performed more than 3,000 microtia reconstructions and was totally dedicated to all aspects of his patients’ care performing the dressing changes for all of them every day until they were discharged three weeks after the procedure. Great sadness has been expressed by the members of the International Society for Auricular Reconstruction, of which he was leading light.
      He had been operating three days a week until the end of the last year and as news of his passing spread at the Nagata Microtia Clinic, patients, families and medical staff were distraught. He is also survived by his wife, Nobuko, and three sons.
      Dr Nagata was a true master of the specialty and will be deeply missed but his spirit will live on not just with his family and friends but also his grateful patients and his colleagues that have leant so much form his pioneering dedication to ear reconstruction.