Total Auricular Reconstruction Using a Single Extended Postauricular Flap Without Skin Grafting in Two Stages: Experiences of 106 Cases

Background Postauricular fascial flap with skin grafting is popular as a solution in total auricular reconstruction, which might result in visible scars and mismatched color, especially in Asian people. Other methods using an expanded postauricular flap to avoid skin grafting often require three or more operations, which increases suffering for patients. This work aims to introduce a modified technique for auricular reconstruction using a single expanded postauricular flap without skin grafting in a two-stage operation. Methods An 80-ml kidney-shaped expander was implanted in the mastoid area as the first-stage operation after preoperative evaluation. After a gradual expansion period and a 2-month rest time, the flap achieved the appropriate size and thickness. In the second stage, a three-layer cartilage framework was fabricated and inserted into the pocket through an incision at the remnant ear, and the earlobe and tragus were rebuilt simultaneously. Results From September 2013 to October 2017, 106 microtia patients were selected for auricular reconstruction applying this method in our hospital. Patients were followed up to 6 months to 4 years. Most of them (93.4%) were satisfied with the reconstructed ears, especially with respect to suitable color and invisible scars. Complications of expander exposure or framework exposure happened in three cases, and all of them finally got a satisfactory result. Conclusion A single large expanded postauricular flap without a skin graft is an effective and efficient technique for auricular reconstruction with satisfying results. It can reconstruct an exquisite ear without a skin graft and can be finished in only two stages of operations.