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A New Method of Total Reconstruction of the Auricle for Microtia
Abstract
This new method for total reconstruction of the auricle is a two-stage operation in which the first stage involves fabrication and grafting of a three-dimensional costal cartilage framework and the second stage is the ear elevation operation. The three-dimensional frame was designed with emphasis on the fabrication of the helical crus, intertragic notch, and antitragus and by extending the crus helicis and fixing it to the undersurface of the base frame. The reconstructed auricle will have four different floors: the cymba and cavum conchae are the bottom (fourth) level, the crus helicis is the third level, the fossa triangularis and the scapha are the second level, and the helix, anthelix, tragus, and antitragus are the top level. The skin incision was made in a W-shaped fashion to create skin flaps with ample surface area to cover the three-dimensional frame without skin grafting. Furthermore, the semilunar costal cartilage was utilized for ear elevation. Thus this new method for total reconstruction of the auricle eliminates the major problems encountered with the conventional method.
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Zhou, G., Jiang, H., Yin, Z., Liu, Y., Zhang, Q., Zhang, C., Pan, B., Zhou, J., Zhou, X., Sun, H., et al. (2018) · EBioMedicine · doi:10.1016/j.ebiom.2018.01.011 · Cited by 329
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Psychosocial Outcome of Patients After Ear Reconstruction: A Retrospective Study of 62 Patients
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“Each patient was offered a “reconstructive menu” consisting of (1) no treatment; (2) a prosthetic ear; (3) an osteointegrated prosthesis; (4) autologous reconstruction with a carved costal cartilage framework.(24,25) The technical details, risks, and benefits of each procedure were thoroughly discussed at consultation.”
MethodBiomedical applications of polyethylene
Paxton, N. C., Allenby, M. C., Lewis, P., & Woodruff, M. A. (2019) · European Polymer Journal · doi:10.1016/j.eurpolymj.2019.05.037 · Cited by 216
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“In most cases, multi-step earlobe reconstruction with autogenous rib cartilage is applied [16—18].”
MethodPorter, C. J. W., & Tan, S. T. (2005) · Plastic and Reconstructive Surgery · doi:10.1097/01.prs.0000161454.08384.0a · Cited by 152
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Self-citationAuricular Reconstruction for Microtia: Part II. Surgical Techniques
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BackgroundSubfascial Expansion and Expanded Two-Flap Method for Microtia Reconstruction
Park, C. (2000) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-200012000-00005 · Cited by 122
Kiefer, J., Arnold, W. J., & Staudenmaier, R. (2006) · ORL · doi:10.1159/000095282 · Cited by 111
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Auricular reconstruction for microtia: A review of available methods.
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Self-citationBirgfeld, C. B., & Heike, C. L. (2019) · Clinics in Plastic Surgery · doi:10.1016/j.cps.2018.12.001 · Cited by 103
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“85 One study that compared the use of rib cartilage versus porous polyethylene implant for microtia reconstruction showed neither material to be superior; however, the polyethylene implants achieved a better cosmetic outcome in terms of ear de fi nition, shape, and size.”
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Bauer, B. S. (2009) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0b013e3181aa0e79 · Cited by 75
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“Initially described by authors such as Converse [16], Tanzer [17], and Brent [18] dealing with large numbers of patients, auricular reconstruction was later developed by Nagata [9–11] and Firmin [21], also with large numbers of patients, and has now been reduced to an operation of two stages.”
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“2– 8 The present modifications and refinements incorporated in the method of costal cartilage harvest for minimization of intraoperative and postoperative complications1 are as follows: (1) the perichondrium is left completely intact at the donor site; and (2) the remaining costal cartilage after fabrication of the th…”
MethodSelf-citationChen, H., Ng, L.-S., Chang, C., et al. (2017) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000003374 · Cited by 60
“5 msec, and (3) geometric accuracy with less than 0.”
BackgroundCheney, M. L., Hadlock, T. A., & Quatela, V. C. (2007) · Local Flaps in Facial Reconstruction · doi:10.1016/b978-0-323-03684-9.50027-x · Cited by 60
“Nagata S. Modification of the stages in total reconstruction of the auricle.”
MethodInfluentialComplication Rate of Autologous Cartilage Microtia Reconstruction
Long, X., Yu, N., Huang, J., & Wang, X. (2013) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0b013e3182aa8784 · Cited by 58
The temporoparietal fascia flap
Jaquet, Y., Higgins, K. M., & Enepekides, D. (2011) · Current Opinion in Otolaryngology & Head & Neck Surgery · doi:10.1097/moo.0b013e328347f87a · Cited by 56
The Temporalis Muscle Flap and Temporoparietal Fascial Flap
Lam, D., & Carlson, E. R. (2014) · Oral and Maxillofacial Surgery Clinics of North America · doi:10.1016/j.coms.2014.05.004 · Cited by 56
Total Ear Reconstruction Using Porous Polyethylene
Ali, K., Trost, J., Truong, T. A., & Harshbarger, R. J. (2017) · Seminars in Plastic Surgery · doi:10.1055/s-0037-1604261 · Cited by 56
Biomechanical evaluation of human and porcine Auricular cartilage
Zopf, D., Flanagan, C. L., Nasser, H. B., et al. (2015) · The Laryngoscope · doi:10.1002/lary.25040 · Cited by 54
Bos, E. J., Scholten, T., Song, Y., Verlinden, J. C., Wolff, J., Forouzanfar, T., Helder, M. N., & van Zuijlen, P. P. M. (2015) · Journal of Cranio-Maxillofacial Surgery · doi:10.1016/j.jcms.2014.12.016 · Cited by 54
“Brent and Nagata (Nagata, 1993).”
Duisit, J., Orlando, G., Debluts, D., Maistriaux, L., Xhema, D., de Bisthoven, Y.-A. J., Galli, C., Peloso, A., Behets, C., Lengelé, B., et al. (2017) · Annals of Surgery · doi:10.1097/sla.0000000000002181 · Cited by 60
Long-term complications of microtia reconstruction: A systematic review
Ronde, E. M., Esposito, M., Lin, Y., van Etten‐Jamaludin, F. S., Bulstrode, N., & Breugem, C. C. (2021) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2021.08.001 · Cited by 55
Cabin, J. A., Bassiri‐Tehrani, M., Sclafani, A. P., & Romo, T. (2014) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2014.07.004 · Cited by 52
Oculo-auriculo-vertebral spectrum: new genes and literature review on a complex disease
Tingaud‐Sequeira, A., Trimouille, A., Sagardoy, T., Lacombe, D., & Rooryck, C. (2022) · Journal of Medical Genetics · doi:10.1136/jmedgenet-2021-108219 · Cited by 52
Ideal scaffold design for total ear reconstruction using a three‐dimensional printing technique
Jung, B. K., Kim, J. Y., Kim, Y. S., Roh, T. S., Seo, A., Park, K. H., Shim, J., & Yun, I. S. (2018) · Journal of Biomedical Materials Research Part B Applied Biomaterials · doi:10.1002/jbm.b.34222 · Cited by 47
Early experience in microtia reconstruction: The first 100 cases
Sabbagh, W. (2010) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2010.07.027 · Cited by 46
Single-Stage Autologous Ear Reconstruction for Microtia
Kasrai, L., Snyder‐Warwick, A. K., & Fisher, D. M. (2014) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000000063 · Cited by 45
Auricular Reconstruction in Hemifacial Microsomia with an Expanded Two-Flap Method
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Naumann, A., Aigner, J., Staudenmaier, R., Seemann, M. D., Bruening, R., Englmeier, K., Kadegge, G., Pavesio, A., Kastenbauer, E. R., & Berghaus, A. (2003) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-003-0636-5 · Cited by 46
“As described by Nagata [32], the first free-floating cartilage should be tapered to facilitate the formation of a helix, and the synchondrotic region of ribs 6 and 7 provides an ample cartilage block to form the framework body (Fig.”
BackgroundTwo-stage reconstruction of the auricle in congenital microtia using autogenous costal cartilage
Cho, B. C., Kim, J. Y., & Byun, J. S. (2007) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2005.12.052 · Cited by 45
Zeng, J., Jia, L., Wang, D., Chen, Z., Liu, W., Yang, Q., Liu, X., & Jiang, H. (2022) · International Journal of Bioprinting · doi:10.18063/ijb.v9i1.631 · Cited by 45
“At present, autologous costal cartilage transplantation has become the most common treatment for microtia[1-5].”
BackgroundCurrent opinion on auricular reconstruction
Sivayoham, E., & Woolford, T. (2012) · Current Opinion in Otolaryngology & Head & Neck Surgery · doi:10.1097/moo.0b013e328355b1d9 · Cited by 44
“The majority of surgeons who perform auricular reconstruction continue to employ the well-established techniques developed by Brent and Nagata.”
MethodInfluentialReconstruction following Traumatic Partial Amputation of the Ear
Pearl, R. A., & Sabbagh, W. (2011) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0b013e318200a948 · Cited by 45
Mechanisms of ear trauma and reconstructive techniques in 105 consecutive patients
Kolodzynski, M. N., Kon, M., Egger, S., & Breugem, C. C. (2017) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-016-4299-4 · Cited by 45
“This is later expounded by Brent [11] and refined by the work of Nagata and Firmin [15].”
MethodQuantitative Evaluation of Mechanical Properties in Tissue-Engineered Auricular Cartilage
Nimeskern, L., van Osch, G. J. V. M., Müller, R., et al. (2013) · Tissue Engineering Part B Reviews · doi:10.1089/ten.teb.2013.0117 · Cited by 43
“13 The autologous framework is first implanted subcutaneously (step 1), that is, there is no separation be-tween the grafted auricle and the skull.”
Atresia Repair Before Microtia Reconstruction
Roberson, J. B., Reinisch, J. F., Colen, T. Y., & Lewin, S. L. (2009) · Otology & Neurotology · doi:10.1097/mao.0b013e3181b23664 · Cited by 42
Wallace, C. G., Mao, H.-Y., Wang, C., Chen, Y.-A., Chen, P. K., & Chen, Z.-C. (2014) · Plastic & Reconstructive Surgery · doi:10.1097/01.prs.0000438052.14011.0a · Cited by 43
“14 It involves (1) harvesting the sixth to ninth costal cartilages entirely subperichondrially, (2) protecting growth centers at the costochondral junctions,19,20 (3) performing donor-site reconstitution with morselized costal cartilage leftovers, and (4) performing perichondrial closure.”
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Xing, W., Kang, C., Wang, Y., et al. (2018) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000004493 · Cited by 41
Zhou, J., Pan, B., Yang, Q., Zhao, Y., He, L., Lin, L., Sun, H., Song, Y., Yu, X., Sun, Z., et al. (2016) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2016.06.011 · Cited by 42
“(3) Pad sculpture: After the main block and helix were scul pted, one or two of the largest remnant pieces were cut flat (similar to the pad).”
BackgroundMethodOu, L.-F., Yan, R.-S., & Tang, Y.-W. (2001) · British Journal of Plastic Surgery · doi:10.1054/bjps.2001.3646 · Cited by 41
3D printing for tissue engineering in otolaryngology
Gesù, R. D., Acharya, A. P., Jacobs, I. N., & Gottardi, R. (2019) · Connective Tissue Research · doi:10.1080/03008207.2019.1663837 · Cited by 41
Ear Reconstruction after Mohs cancer excision: lessons learned from 327 consecutive cases
Sanniec, K., Harirah, M., & Thornton, J. F. (2019) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000005992 · Cited by 39
Hemifacial Microsomia Review: Recent Advancements in Understanding the Disease
Paul, M. A., Opyrchał, J., Knakiewicz, M., et al. (2020) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000006616 · Cited by 39
Prediction of difficult airway in school‐aged patients with microtia
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Self-citationUse of an Expanded Temporoparietal Fascial Flap Technique for Total Auricular Reconstruction
Park, C., & Mun, H. Y. (2006) · Plastic & Reconstructive Surgery · doi:10.1097/01.prs.0000227735.88820.98 · Cited by 39
Systematic Review of Medpor Versus Autologous Ear Reconstruction
Ma, Y., & Lloyd, M. S. (2021) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000008130 · Cited by 38
Expanded Retroauricular Skin and Fascial Flap in Congenital Microtia Reconstruction
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“[8] Nagata S.”
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“4-stage Brent procedure [36] or 2-stage Nagata procedure [37]) is recognized as surgically demanding and involves harvesting of a large amount of autologous donor cartilage for subsequent shaping.”
BackgroundChen, Z.-C., Goh, R. C. W., Chen, P. K.-T., Lo, L., Wang, S.-Y., & Nagata, S. (2009) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0b013e3181babaf9 · Cited by 37
Self-citationOtoplasty and Auricular Reconstruction
Siegert, R., & Magritz, R. (2019) · Facial Plastic Surgery · doi:10.1055/s-0039-1693745 · Cited by 37
Chen, Z.-C., Albdour, M. N., Lizardo, J. A., Chen, Y.-A., & Chen, P. K.-T. (2015) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2015.02.020 · Cited by 37
“Conchae (Deepest Portion), (12) Lobule Posterior, (13) Lobule”
Technical innovations in ear reconstruction using a skin expander with autogenous cartilage grafts
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Park, C., Yoo, Y.-S., & Hong, S.-T. (2010) · Current Opinion in Otolaryngology & Head & Neck Surgery · doi:10.1097/moo.0b013e32833fecb9 · Cited by 37
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Long-term follow-up of osseointegrated auricular reconstruction
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Patients' satisfaction after ear reconstruction with autologous rib cartilage
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“At the Scandinavian Ear Reconstruction Centre, ears are created by autologous rib cartilage using a three-stage technique by Wikström, based on techniques of Brent [5] and Nagata [6].”
MethodAuricular Reconstruction from Rib to 3D Printing
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Biofabrication of a shape-stable auricular structure for the reconstruction of ear deformities
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Aesthetic auricular reconstruction with autologous rib cartilage grafts in adult microtia patients
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Skin Grafting on 3D Bioprinted Cartilage Constructs In Vivo
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Microtia Reconstruction With Adjuvant 3-Dimensional Template Model
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“The autogenous costal cartilage auricular reconstruc- tion for microtia achieves significant improvement after the introduction of the evolutional surgical technique by Dr. Satoru Nagata.1 The 3-dimensional frame introduced by Dr. Nagata is carved according to a fixed ratio in reference to the anthropological statisti…”
BackgroundWang, Y., Xing, W., Liu, T., et al. (2018) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2018.07.004 · Cited by 29
Cuccolo, N. G., Zwierstra, M. J., Ibrahim, A. M. S., Peymani, A., Afshar, S., & Lin, S. J. (2019) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000002318 · Cited by 30
The burned ear; possibilities and challenges in framework reconstruction and coverage
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Use of an Expanded Temporoparietal Fascial Flap Technique for Total Auricular Reconstruction
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Refinements in the Elevation of Reconstructed Auricles in Microtia
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Alternative surgical methods of treatment for the constricted ear
Nagata, S. (2002) · Clinics in Plastic Surgery · doi:10.1016/s0094-1298(01)00015-3 · Cited by 29
Self-citationNeurovascular Free-Muscle Transfer to Treat Facial Paralysis Associated with Hemifacial Microsomia
Takushima, A., Harii, K., Asato, H., et al. (2002) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-200204010-00001 · Cited by 29
Cartilage exposure following autologous microtia reconstruction: An algorithmic treatment approach✰
Cugno, S., & Bulstrode, N. (2018) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2018.11.006 · Cited by 28
Auricular reconstruction: where are we now? A critical literature review
Humphries, S., Joshi, A. K., Webb, W. R., & Kanegaonkar, R. G. (2021) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-021-06903-5 · Cited by 28
External Ear Reconstruction in Hemifacial Microsomia
Yamada, A., Ueda, K., & Yorozuya-Shibazaki, R. (2009) · Journal of Craniofacial Surgery · doi:10.1097/scs.0b013e3181b5d519 · Cited by 28
“There is an argument about whether a subcutaneous pedicle is necessary for the posterior mastoid flap.(15,16,26,27) On the basis of our experience, we keep a subcutaneous pedicle attached to the conchal flap to prevent vascular compromise.”
BackgroundPrefabricated, Ear-Shaped Cartilage Tissue Engineering by Scaffold-Free Porcine Chondrocyte Membrane
Liao, H.-T., Zheng, R., Liu, W., et al. (2015) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000001105 · Cited by 28
“8,9 The advantages are (1) there is no need for a scaffold to support chondrocyte growth because the extracellular matrix is produced by chondrocytes themselves and (2) the shape can be maintained by preformed support without the need for a longterm sculpture time.”
Background
Metadata
- Authors
- Nagata, S.
- Corresponding author
- Nagata, Satoru
- Venue
- Plastic and Reconstructive Surgery
- Published
- 1993-08
- Volume
- 92
- Issue
- 2
- Pages
- 187-201
- ISSN
- 0032-1052 (ISSN-L)
- OpenAlex
- W2002001684
- Cited by
- 640
- References
- 0
- Citations by year
- 2026: 25 · 2025: 34 · 2024: 34 · 2023: 37 · 2022: 21 · 2021: 43 · 2020: 95 · 2019: 42 · 2018: 37 · 2017: 22 · 2016: 23 · 2015: 25 · 2014: 28 · 2013: 20 · 2012: 17
- FWCI
- 0.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Plastic & Reconstructive Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Health Sciences › Medicine › Genetics (clinical) › Congenital Ear and Nasal Anomalies
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Keywords
- microtia, ear reconstruction, two-stage reconstruction, skin flaps
- MeSH terms
- Adolescent, Cartilage, Child, Ear, External, Female, Humans, Male, Reoperation, Surgery, Plastic, Surgical Flaps, Suture Techniques, Time Factors
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