Auricular Reconstruction for Microtia: Part II. Surgical Techniques

Abstract

Reconstruction of the microtic ear represents one of the most demanding challenges in reconstructive surgery. In this review the two most commonly used techniques for ear reconstruction, the Brent and Nagata techniques, are addressed in detail. Unique to this endeavor, the originator of each technique has been allowed to submit representative case material and to address the pros and cons of the other's technique. What follows is a detailed, insightful overview of microtia reconstruction, as a state of the art. The review then details commonly encountered problems in ear reconstruction and pertinent technical points. Finally, a glimpse into the future is offered with an accounting of the advances made in tissue engineering as this technology applies to auricular reconstruction.

Manejo actual de la microtia: redefinición anátomo-quirúrgica

“…Numerosas modificaciones a la técnica quirúrgi-ca se han realizado en los últimos 20 años, las más aceptadas últimamente tanto por su calidad y reproductibilidad han sido las de Brent y Nagata 8 . Estos dos últimos autores han clasificado los remanentes auriculares en microtias clásicas o atípicas con su abordaje respectivo.…”

“…En nuestra experiencia, la utilización de cartíla-go autólogo ha demostrado ser la mejor alternativa terapéutica para estos pacientes. A pesar de ello los materiales protésicos deben ser considerados en pacientes con alteraciones en los tejidos locales debidos a intervención quirúrgica previa, irradiación, cáncer, etc 8 . En cuanto a las limitaciones del estudio, no se realizó un trabajo comparativo entre las distintas téc-nicas quirúrgicas por un mismo cirujano.…”

Applied Basic Science of the Auricular Cartilage

“…As mentioned earlier, reconstructive surgeon should use synthetic or tissue engineered cartilage that provides the anatomical and biomechanical properties of the human auricle to achieve good biocompatibility with the skin [12], adequate mechanical properties prevent deformation of the implant when implanted beneath the skin providing definition of the auricle shape. Also, similar mechanical properties to the surrounding tissue prevent stress at the interface [1]; mechanical mismatch can lead to micromovement between the skin and the implant when subcutaneously implanted [13], thus implant failure and extrusion.…”

Textbook of Plastic and Reconstructive Surgery

“…Silicone colour matching is based on patient's skin tone; however, with sun exposure, the prosthesis may become more evident because of changes in the colour of surrounding skin. Several ways of attaching the prosthesis are available: it can be attached using an adhesive, hooked into a body edge or attached to a surgically implanted and osseointegrated titanium screw (Walton & Beahm, 2002). The latter is the most effective in ensuring higher retention of the prosthesis to the head; nevertheless, there are a few disadvantages, including the possibility of infection and inflammation around the screw.…”