A Modified Method for Ear Projection in Auricular Reconstruction: Split-Thickness Skin Graft Combined with Retroauricular Fascia Flap

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BACKGROUND: The 2-stage Nagata technique is one of the most prevalent methods for auricular reconstruction. Nevertheless, in the second stage, the use of a temporoparietal fascial flap usually requires an additional incision, and the procurement of donor skin from the groin or chest area can result in extra scarring, which may reduce patients' satisfaction with the surgical outcomes. METHODS: The authors propose a refined method using a retroauricular fascia flap combined with a split-thickness skin graft for postauricular coverage, which can avoid additional scarring in the temporoparietal and donor skin area. From April of 2019 to January of 2024, auricular reconstructions on 337 ears across 324 patients were performed using this novel technique. The classification of microtia, duration of surgery, and postoperative complications were recorded. The authors finally evaluated the scar condition and patient satisfaction with surgery outcomes in the 1- to 2-year postoperative period. RESULTS: In the authors' study, 154 patients were diagnosed with lobule-type microtia, 53 patients were diagnosed with small concha-type microtia, 62 patients were diagnosed with concha-type microtia, and 55 patients were diagnosed patients with anotia. The average duration of the second-stage surgery was 2.8 hours. Patients who underwent this modified technique exhibited no noticeable long-term postoperative scarring and no instances of flap necrosis, framework deformation, cartilage exposure, infection, or mismatched skin color following the procedure. Furthermore, 94% of the patients reported satisfaction with the surgical outcomes. CONCLUSION: The use of continuous split-thickness skin grafts, combined with a retroauricular fascial flap, offers a safe, effective, and aesthetically pleasing solution for second-stage auricular projection.

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