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Auricular Reconstruction Using Cadaveric Costal Cartilage: Initial Outcomes and 5-Year Perspective
Brittany M. Lala
*, Alexandra Townsend, Oren Tepper
Plastic Surgery, Montefiore Medical Center, New York, NY, NY
Background: Treatment of microtia classically involves reconstructing the auricular framework using autologous costal cartilage. While autologous costal cartilage remains the gold standard, its use is associated with notable donor site morbidity. Cadaveric costal cartilage has been utilized in nasal reconstruction; however, there is a paucity of literature regarding its application in auricular reconstruction. This study presents the clinical outcomes of microtia reconstruction using cadaveric costal cartilage, performed by a single senior surgeon.
Methods: A retrospective review was performed of patients who underwent microtia reconstruction using MTF Biologics (Edison, NJ) cadaveric costal cartilage by a single surgeon over a 5-year period. Complications including infection and cartilage exposure were evaluated. Outcomes including successful reconstruction and reconstructive failure were assessed.
Results: A total of 18 ears (17 patients) were reconstructed with cadaveric costal cartilage over 5 years. Cadaveric costal cartilage was used to create the primary construct in 12 of the ears and used to elevate the framework or revise the helical rim or lobule in 6 ears. All patients had a diagnosis of microtia, most commonly grade III. Patients' ages ranged from 7 to 22 years at the time of surgery. Follow up time ranged from 1 month to 4.5 years (mean 10 months). Four ears developed construct exposure - 2 of which required local flaps, 2 healed spontaneously. Four infections occurred, 2 required partial construct resection. The other 2 ears were a bilateral reconstruction in a patient with type 1 diabetes, which required explantation. After implementing intraoperative irrigation into our protocol, infection rate fell to 0%.
Conclusion: Cadaveric costal cartilage is a promising alternative to autologous cartilage in microtia reconstruction. However, longer-term studies and a larger patient population are needed to further validate its use as an alternative for auricular framework reconstruction.
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