The aim of this article is to report the application of expanding retroauricular skin fascia flap, and autogenous costal cartilage for congenital microtia reconstruction.Microtia reconstruction was generally completed in 3 surgical stages. In the first surgical stage, a 50 or 80 mL kidney-shaped tissue expander was inserted subcutaneously in the retroauricular mastoid region. Inflation of saline volume increased up to 60 to 80 mL, and skin flap was expanded for 2 to 3 months postoperatively. In the second surgical stage, removal of tissue expander, formation of retroauricular skin flap, elevation of retroauricular fascia flap, and pedicles of both flaps in remnant ear side were performed. Costal cartilage was harvested from ipsilateral side chest to the ear for reconstruction. The 3D ear framework was sculpted with stabilization of structure, contour and erection. Simultaneously, intermediate full thickness skin graft of 4 x 8 cm was obtained from previous incision site from where costal cartilage was harvested. Cartilage ear framework was anchored between skin flap and fascia flap, and fixed it symmetrically to the opposite normal ear, inferior portion of the ear framework was wrapped by remnant ear lobule, expanded skin flap covered the anterior portion of the framework, fascial flap was draped to the posterior side of framework and helical rim, then fascial flap was surfaced by intermediate full thickness skin graft. Suction drain was inserted and coated between skin flap and framework, drain was removed fifth postoperative day. Tragus construction and conchal excavation with skin graft was performed in the third stage of microtia reconstruction.Between October 2000 and October 2007, 426 cases were diagnosed as unilateral microtia patients and 22 cases were bilateral microtia patients. Therefore, 448 microtia ears were treated with tissue expander and autogenous costal cartilage. In 262 cases, structure of the helix, tragus, conchal excavation, auriculocepahalic angle, and symmetry to opposite normal ear were satisfied in the follow-up period of 6 months to 4 years. Antihelix, triangular fossa, and scapha were prominent with good result in most of the patients.Expanded retroauricular skin flap combined with fascial flap can cover the different size and height of cartilage ear framework in single surgical stage. At the same time, on the basis of structure stability and contour reality of cartilage framework, we can achieve fine structure and erect stability of constructed auricle. This method affords ideal results in microtia reconstruction.

Objective To explore surgical procedure of congenital bilateral microtia.Methods From March 2007 to June 2008,Bilateral ear reconstruction was made in the same stage in 21 patients.In the first stage we implant a 50ml expander in either posterior side of auricular.In the second stage we use autogenous rib cartilage framework to reconstruct bilateral ear and In the third stage reconstruct tragus and repair the wound using the reserving leftover ear.Results Long time follow-up from 6 months to one year,except 2 cases showed that the cartilage somewhat resorption or deformation,the other cases showed that the reconstructed ears were coincidence with the face on location,form and dimension.Conclusions It was a good method for congenital bilateral microtia to use soft tissue skin expander together with autogenous rib cartilage framework at the same time.