A new technique for transcutaneous fixation of the costal cartilage block utilized in reconstructed ear elevation for microtia

Purpose: With the aim of implementing good projection of the three-dimensional frame (auriculo-cephalic angle) and maintaining projection, a significant issue during the stage of auricular elevation for avoiding the potential for dislodging the cartilage blocks remains. Herein we present an innovative and technically simple method of transcutaneous fixation of the costal cartilage block during the stage of auricular elevation. Materials and methods: After elevation of ear frame from the basement, two suspension stitches on the surface of the elevated ear were used to fix the embedding cartilage block into the auriculo-cephalic sulcus at the upper (bifurcation point of the anti-helix where the inferior and superior crus meet to form the triangular fossa) and lower (projection point of the concha wall, parallel to the level of the tragus) ones. A loop of suture was placed through a dermal anchor, ear frame, and piece of the cartilage block. Results: Among a total of 50 patients, 94% achieved 'excellent' and 'good' outcomes in terms of auricular symmetry. Likewise, 86% (n = 43) of patients achieved 'excellent' and 'good' outcomes in terms of projection in postoperative 6-month follow-up. There were no instances of significant cartilage or knot exposure or absorption of the embedded cartilage blocks. Conclusion: The technique of transcutaneous fixation of cartilage blocks for ear elevation described in this study was associated with excellent outcomes, producing stable clinical results based on our long-term experience with ear reconstruction. (c) 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.