Microtia reconstruction using tissue expanders without skin grafts from groin region

Backgrounds Microtia reconstruction is a multistage procedure for which a variety of surgical strategies have been devised. Most surgeons continue to employ the long-established two-stage procedures described by Nagata and Firmin, which use autogenous rib cartilage for auricular reconstruction. The groin area is the most common donor site for full-thickness skin grafts in auricular elevation, the second stage. In this article, we present a new method that uses tissue expanders before auricular elevation, which provides the necessary skin and creates satisfactory results without groin scarring. Methods The surgical procedure is composed of three stages. In the first stage, we performed the rib-cartilage graft as previously described. In the second stage, a 45-ml rectangular tissue expander was inserted subcutaneously at the postauricular mastoid region. The skin flap was expanded for 3-4 months before auricular elevation. In the next stage, the expanded postauricular skin flap was advanced to the mastoid area and set into the auriculocephalic sulcus after removing of the tissue expander. The estimated remnant skin flap and dog-ears were marked and then excised. After a defatting procedure, the harvested skin was reused for the elevation procedure, obviating the need for full-thickness skin from the groin. Results Between January 2011 and January 2014, 62 cases of microtia were treated with our method. The final results showed no major complications and satisfactory aesthetics, with fine structure, symmetry, maintenance of the auriculocephalic angle, and erect stability of the cartilage framework. Conclusion Various procedures using tissue expanders have been introduced in microtia reconstruction. However, they utilized complicated strategies for tissue expanders or obtained suboptimal aesthetic results. With our simple and reproducible methods, we can obtain satisfactory aesthetic results using expanded skin without the additional morbidity of a donor site. Despite the addition of an operation procedure, patient satisfaction with regard to the lack of groin scarring was much higher than expected.