Proof of Concept for A Novel Technique for Autologous Microtia Repair.
Angelo A. Leto Barone, MD1, Anirudh Arun, MD1, Georges J. Samaha, MD2, Christopher C. Shallal1, Richard J. Redett, III, MD1, Jordan P. Steinberg, MD, Ph.D1.
1Johns Hopkins Hospital, Baltimore, MD, USA, 2University of Miami, Miami, FL, USA.
BACKGROUND: Autologous microtia reconstruction currently requires harvesting of the cartilaginous portion of four ribs followed by precise carving, assembling, and fixation of the different subunits obtained in order to reproduce an anatomically accurate auricular framework. This technique yields excellent results in the hands of master surgeons. However, this procedure often suffers from the lack of abundant cartilage, has a steep learning curve, is operator-dependent, is time-consuming, carries a significant donor-site morbidity, requires typically two stages, and frequently results in suboptimal results leading to poor patient satisfaction. Herein we describe our proof of concept for a novel technique of autologous microtia repair made possible through the use of AuryzoN™, a novel device that allows rapid production of a high-quality auricular framework. METHODS: In a first step, the device precisely slices longitudinally the full-thickness cartilage to obtain the desired framework thickness, while simultaneously duplicating the amount of cartilage available. Subsequently, the cartilage of the desired thickness is placed over the device and cut precisely into the shape of the different auricular subunits. The abundance of cartilage allows production of a posterior pedestal that allows immediate projection of the ear. The subunits are then assembled using wire suture. RESULTS: Our proof-of-concept tests on silicone models revealed the ability to produce a highly accurate framework in minutes. Slicing the cartilage can allow for a doubling of the overall available amount of substrate, yielding a “cartilage-sparing” technique that requires less overall cartilage to safely produce an entire auricular framework. Two and a half ribs (6th, 7th and part of the 8th) are used instead of the traditional four from prior techniques.
CONCLUSIONS: In summary, we present a novel device that can improve autologous microtia repair by standardizing quality of the cartilaginous construct while minimizing the need for donor material, operative time, and staging. We hypothesize that the high-profile construct could be placed under a temporoparietal fascia flap and then covered with a thin full-thickness skin graft to produce acceptable and reproducible results. 
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