Clinical application and experience summary of modified total expanded flap technique in auricle reconstruction

Objective To summarize the clinical experience of auricular reconstruction using modified total expanded flap technique to treat congenital microtia, and discuss how to improve the use of this technique. Methods A total of 40 single-sided congenital microtia patients, aged more than nine years old, with ample retroauricular skin were selected, who were admitted into Department of Plastic Surgery, the Affiliated Hospital of Xuzhou Medical University from March of 2016 to December of 2018. The patients underwent auricular reconstruction using modified total expanded flap technique. The surgery was carried out in three stages. In the first stage, an expander was implanted in the mastoid followed by laser hair removal. Then, total auricular reconstruction was performed in the second stage, and the reconstructed ear was trimmed in the third stage. Results All patients underwent ear reconstruction. After surgery, all incisions healed at stage I, and skin flaps and ear scaffolds survived well without infection. The patients were followed up for 6 to 24 months, with an average of 16 months. The reconstructed ears showed good appearance, with closely similar color and texture to those on the contralateral side. Moreover, 32 patients (80.0%) were satisfied with their reconstructed ears, while 8 patients (20%) rated their outcomes as acceptable. The length of the chest wall scar was less than 3.5 cm in 38 patients (95%), with the shortest being only 1.8 cm. There was no obvious chest wall deformity. Conclusions Based on strict selection in accordance with indications, modified total expanded flap technique can produced the ears with good appearance, clear and natural outline, was well as small scars and stable effect, which is an ideal approach to treat congenital microtia.