An Algorithm and Aesthetic Outcomes for a Coverage Method for Large- to Medium-Remnant Microtia: I. Coverage in the One-Stage Erect Position

Abstract

Background: When reconstructing large-to medium-remnant microtia cases, one of the greatest dilemmas is how to deal with the variable shape and volume of the three-dimensional skin remnant for coverage of a newly sculptured three-dimensional framework. There are few guidelines for using the remnant skin adequately for achieving satisfactory aesthetic outcomes of the reconstructed ears. Methods: Nineteen large-remnant microtia patients who underwent reconstruction in the one-stage erect position between 2006 and 2010 were reviewed. According to the volume and shape of skin of the microtia remnant, different coverage methods were used. Aesthetic outcome in each case was evaluated by scores and, based on volume and shape of the remnant and the patient's final aesthetic scores, an algorithm for coverage methods is provided. Results: Four coverage types were defined, and their application can be described in an algorithmic approach: three patients underwent reconstruction without additional skin coverage (option I); eight underwent reconstruction by the addition of a mastoid fascial flap into the conchal region (option II); one underwent reconstruction by the addition of an arterial skin flap (option III); and seven underwent reconstruction by the addition of a temporoparietal fascial flap into the superior auricle (option IV). Adequate reconstructive procedure, indications, and limitations for each case are presented. Conclusions: With the presented algorithmic approach, the remnant skin in each large-remnant microtia case was maximally and adequately used for reconstruction in the one-stage erect position by the least invasive surgical procedure. Better aesthetic outcomes are expected if this algorithmic approach is applied. (Plast. Reconstr. Surg. 129: 803e, 2012.)