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Total Ear Reconstruction Using Cadaveric Costal Cartilage in 11 Patients
Nicholas Bastidas MD1; Nissim Hazkour BA2; Jose Palacios BS3; Robin Rivera FNP-BC1
1Northwell Health Division of Plastic and Reconstructive Surgery, Manhasset, NY2SUNY Downstate College of Medicine, Brooklyn, NY3Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY

Objective: Allogeneic cadaveric cartilage is commonly used for grafts in nasal reconstruction surgery; however, limited information exists on its use in total ear reconstruction for type III microtia. In this case series we describe the novel use of cadaveric cartilage for auricular framework construction in ear reconstruction and review preliminary histologic evidence of long term cadaveric cartilage viability.
Methods: Patients requiring complete reconstruction of the auricle from August 2020 to December 2021 were eligible and underwent ear reconstruction using cadaveric costal cartilage. Patients were evaluated for surgical site infection (SSI), skin necrosis, cartilage resorption, and cartilage exposure during regular follow up visits. Two cartilage samples were taken after two separate second stage surgeries which were done 52 weeks post first stage reconstruction. These samples were histologically assessed for chondrocyte viability, host incorporation, local inflammation and immune rejection.
Results: A total of 13 ear reconstruction procedures using cadaveric costal cartilage were performed across 11 patients; 9/13 ears were type 3 microtia, 1/13 was type 4 microtia, 2/13 were revisions of previous reconstruction. Patients ranged from 4 51 years old at the time of surgery, with an average age of 13 years for primary reconstruction. Follow up time ranged from 12 to 64 weeks, with a mean follow up time of 32 weeks. No patients experienced any visibly significant cartilage resorption or warping. One patient experienced partial exposure of the construct, which was successfully salvaged with a local TPF flap. One patient experienced a fungal infection that was successfully treated with topical anti-fungal medication. One revision patient with a previous TPF flap whom we attempted to replace with a new construct had flap necrosis requiring explantation. The second revision patient experienced a bacterial infection requiring explantation. Of the 11 primary ear reconstructions performed, none had postoperative complications related to the use of the cadaveric cartilage. Preliminary histologic analysis of the two samples taken 1 year post-implantation showed viable chondrocytes that depict host incorporation. Furthermore, there was no evidence of immunologic rejection or any local inflammation/host foreign body response.
Conclusion: Cadaveric costal cartilage serves as a viable alternative to autologous cartilage and other alloplastic biomaterials for construction of auricular frameworks in microtia reconstruction. Preliminary histologic results are promising, but longer follow up times and an increased sample size are needed for assessment of long-term efficacy.


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