Cited by 640Reconstructive Facial Surgery TechniquesCongenital Ear and Nasal AnomaliesNasal Surgery and Airway Studies

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A New Method of Total Reconstruction of the Auricle for Microtia

Nagata, Satoru·1993·Plastic and Reconstructive Surgery

DOI 10.1097/00006534-199308000-00001

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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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Items 101–200 of 638

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“In this group of cases, healthy periauricular skin, or scarred but supple enough for forming a pocket, principle used in microtia reconstruction can be followed, which were advocated by Brent and Byrd(12) and Nagata.(13) Reconstruction is arranged in a staged fashion (Figs.”
Background
Preferential Associated Malformation in Patients With Anotia and Microtia
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Self-citation
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Background
Modification in the Technique of Ear Framework Fabrication for Congenital Microtia
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“The total perichondriawere left in situ, which was preserved to provide the most ideal environment for cartilage regeneration.(10,11)”
Background
The Occipital Artery–Based Fascial Flap for Ear Reconstruction
Reinisch, J. F., Westerflier, C. V. A. V. H. T., Tahiri, Y., et al. (2018) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000005263 · Cited by 22
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Method
Reconstruction of congenital microtia by using a tissue expander.
Hata, Y., & Umeda, T. (2000) · PubMed · Cited by 22
Ex Vivo Electromechanical Reshaping of Costal Cartilage in the New Zealand White Rabbit Model
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Firm elevation of the reconstructed auricle with a retroauricular fascial flap wrapping an EH (a mixture of epoxide acrylate malelic and hydroxyapatite) composite wedge
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“Since Tanzer’s(1) introduction of four-stage ear reconstruction in 1959, several modifications and improvements have been made, including the reconstructive methods proposed by Brent(2) and Nagata.(3) Currently, Nagata’s(3) two-stage surgery is the most commonly performed auricular reconstruction procedure.”
BackgroundMethodInfluential
Three-Dimensional Mock-Up Model for Chondral Framework in Auricular Reconstruction, Built with a Personal Three-Dimensional Printer
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“When projection is desired, a second-stage operation allows for elevation of the pocketed construct and coverage of the postauricular defect with fascia (such as TPF) and a skin graft from an appropriate donor site.(19,20) At the second operation, projection is sometimes achieved with a wedge of banked cartilage.”
Background
Bilateral microtia reconstruction
Liu, X., Zhang, Q., Quan, Y.-Z., et al. (2009) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2009.07.017 · Cited by 21
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A Simple Negative Suction Drain for Ear Reconstruction
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“Methods can be one-stage or typically multi-stage (four-stage Brent, two-stage Nagata) and all have advantages and pitfalls [117, 118].”
Background
Integrated protocol of auricle reconstruction combined with hearing reconstruction
Zhao, S., Wang, D., Han, D., et al. (2012) · Acta Oto-Laryngologica · doi:10.3109/00016489.2012.662716 · Cited by 19
“The modified Brent method (two stages) was used in these patients [2,3], which is similar to the Nagata method [4].”
Method
Auricular reconstruction of congenital microtia: personal experience in 225 cases.
Anghinoni, M. L., Bailleul, C., & Magri, A. S. (2015) · PubMed Central · Cited by 19
Preliminary Analysis on Characteristics of Rib Cartilage Calcification in Patients With Congenital Microtia
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Argon plasma modified nanocomposite polyurethane scaffolds provide an alternative strategy for cartilage tissue engineering
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“Since then Brent and Nagata modified the technique to a two-stage procedure, which has now become the most commonly used method of autologous ear reconstruction [7, 8].”
Method
A Novel Method of Naturally Contouring the Reconstructed Ear
Li, D., Zhang, R., Zhang, Q., et al. (2014) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000000129 · Cited by 19
“Satisfactory auricular reconstruction depends on the following three factors: (1) positioning of the reconstructed ear, (2) dimensions of the graft, and (3) details of the framework.”
Background
New Training Method of Creating Ear Framework by Using Precise Copy of Costal Cartilage
Yamada, A., Imai, K., Fujimoto, T., Morimoto, K., Niitsuma, K., & Matsumoto, H. (2009) · Journal of Craniofacial Surgery · doi:10.1097/scs.0b013e3181a2ef97 · Cited by 20
“Advantages of potato and carrots for exercise are as follows: (1) cheap, (2) available anytime, anywhere, and (3) does not require special preparation.”
Background
CT Measured Normative Cartilage Growth in Children Requiring Costochondral Grafting
Andreoli, S. M., Mills, J. C., Kilpatrick, L. A., White, D. R., & Patel, K. G. (2013) · Otolaryngology · doi:10.1177/0194599813504071 · Cited by 19
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Chung, J. H.-Y., Kade, J. C., Jeiranikhameneh, A., Yue, Z., Mukherjee, P., & Wallace, G. G. (2018) · Bioprinting · doi:10.1016/j.bprint.2018.e00031 · Cited by 20
“This is some of the reasons why several studies prefer Brent’s technique over Nagata’s as it requires less cartilage, but also delaying the surgery till the patient is much older [23, 30].”
BackgroundInfluential
Artificial intelligence for assessing the severity of microtia via deep convolutional neural networks
Wang, D., Chen, X., Wu, Y., Tang, H., & Deng, P. (2022) · Frontiers in Surgery · doi:10.3389/fsurg.2022.929110 · Cited by 18
“Then, the two-stage reconstruction procedure was developed by Brent (4) and Nagata (5).”
Method
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Takase, M., Hashimoto, I., Nakanishi, H., et al. (2008) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2007.11.030 · Cited by 18
Reconstruction of the auricle.
Siegert, R., & Magritz, R. (2007) · PubMed Central · Cited by 22
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Ono, I. (2002) · Annals of Plastic Surgery · doi:10.1097/00000637-200202000-00001 · Cited by 18
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Microtia Ear Reconstruction Using Tissue Expander and Autologous Costal Cartilage: Our Experience and Comparing Two Age Groups.
Tripathee, S., Xiong, M., & Zhang, J. (2019) · PubMed · doi:10.29252/wjps.8.3.324 · Cited by 17
Osseointegrated implants for auricular prostheses: An alternative to autologous repair
Ryan, M. A., Khoury, T., Kaylie, D. M., Crowson, M. G., Brown, C. S., McClennen, J., & Raynor, E. M. (2018) · The Laryngoscope · doi:10.1002/lary.27128 · Cited by 18
Surgical-Based Classification for Microtia
Campo, A. A., Baldin, A. V., & Mérida, S. C. (2018) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000004772 · Cited by 16
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Ladani, P., Valand, R., & Sailer, H. F. (2018) · Journal of Maxillofacial and Oral Surgery · doi:10.1007/s12663-018-1158-4 · Cited by 17
Review of 602 Microtia Reconstructions: Revisions and Specific Recommendations for Each Subtype
Kim, A., Lee, H., & Oh, K. S. (2020) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000006906 · Cited by 17
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Alhazmi, B., Alshomer, F., & Alawirdhi, B. (2021) · JPRAS Open · doi:10.1016/j.jpra.2021.03.004 · Cited by 17
“Generative Design”: An Explorative Study
Buonamici, F., Carfagni, M., Furferi, R., et al. (2020) · GI-Fachtagung CAD · doi:10.14733/cadconfp.2020.6-10 · Cited by 141
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Byun, S. S., Hong, P., & Bezuhly, M. (2016) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000002900 · Cited by 17
Total ear reconstruction in postburn deformity
Bhandari, P. S. (2002) · Clinics in Plastic Surgery · doi:10.1016/s0094-1298(01)00012-8 · Cited by 17
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Li, Y., Zhang, R., Zhang, Q., et al. (2016) · Aesthetic Plastic Surgery · doi:10.1007/s00266-016-0743-5 · Cited by 16
New Strategies for Tragus and Antitragus Complex Fabrication in Lobule-Type Microtia Reconstruction
Xu, Z., Zhang, R., Zhang, Q., et al. (2019) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000006043 · Cited by 16
Three-dimensional bioprinting of auricular cartilage: A review
Jiang, R., Guo, W., Zhang, J., Zhang, X., Zhou, L., & Xu, T. (2019) · Medicine in Drug Discovery · doi:10.1016/j.medidd.2020.100016 · Cited by 16
Improving In Vitro Cartilage Generation by Co-Culturing Adipose-Derived Stem Cells and Chondrocytes on an Allograft Adipose Matrix Framework
Ziegler, M. E., Sorensen, A. M., Banyard, D. A., Evans, G. R. D., & Widgerow, A. D. (2020) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000007511 · Cited by 16
Three-Dimensional-Printed External Scaffolds Mitigate Loss of Volume and Topography in Engineered Elastic Cartilage Constructs
Dong, X., Premaratne, I. D., Bernstein, J. L., Samadi, A., Lin, A. J., Toyoda, Y., Kim, J.-K., Bonassar, L. J., & Spector, J. A. (2021) · Cartilage · doi:10.1177/19476035211049556 · Cited by 17
“The 2 techniques utilized involved (1) a preformed construct that is secondarily placed within the external scaffold (S) versus (2) an injection molding technique where the construct is formed in situ within the external scaffold (SInj) to increase interfacial bonding between the collagen and the external scaffold.”
BackgroundMethod
Reconstruction of a Three-Dimensional Structure Using Cartilage Regenerated from the Perichondrium of Rabbits
Yotsuyanagi, T., Urushidate, S., Watanabe, M., et al. (1999) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-199904040-00002 · Cited by 16
Tissue Expansion Using Hyaluronic Acid Filler for Single-Stage Ear Reconstruction: A Novel Concept for Difficult Areas
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Aesthetic Auricular Reconstruction in Adult Patients with Rib Cartilage Calcification Using a Modified Two-Step Technique
Xing, W., Wang, Y., Qian, J., et al. (2018) · Aesthetic Plastic Surgery · doi:10.1007/s00266-018-1206-y · Cited by 16
History of Auricular Reconstruction
Weerda, H. (2010) · Advances in oto-rhino-laryngology · doi:10.1159/000314560 · Cited by 16
Long-term in vivo electromechanical reshaping for auricular reconstruction in the New Zealand white rabbit model.
Badran, K. W., Manuel, C. T., Loy, A. C., Conderman, C., Yau, Y. Y., Lin, J., Tjoa, T., Su, E., Protsenko, D., & Wong, B. J. F. (2015) · The Laryngoscope · doi:10.1002/lary.25237 · Cited by 16
Auricular reconstruction with modified expanded two-flap method in Goldenhar Syndrome: 7-Year experiences
Xing, W., Qian, J., Wang, B., et al. (2020) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2020.110228 · Cited by 15
Simultaneous Bilateral Microtia Reconstruction Using Single-Expanded Postauricular Flap Without Skin Grafting
Xing, W., Wang, Y., Qian, J., et al. (2018) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000001628 · Cited by 15
The Utility of Smartphone 3D Scanning, Open-Sourced Computer-aided Design, and Desktop 3D Printing in the Surgical Planning of Microtia Reconstruction: a Step by Step Guide and Concept Assessment
Alazzam, A., Aljarba, S. I., Alshomer, F., & Alawirdhi, B. (2021) · JPRAS Open · doi:10.1016/j.jpra.2021.06.001 · Cited by 15
Reconstruction of the auricle
Kobus, K., Szczyt, M., L·tkowski, I., & Wójcicki, P. (2002) · British Journal of Plastic Surgery · doi:10.1054/bjps.2002.3966 · Cited by 15
Long-Term Quality of Life Assessment in Patients With Auricular Prostheses
Kievit, H., Verhage-Damen, G. W. J. A., Ingels, K. J. A. O., et al. (2013) · Journal of Craniofacial Surgery · doi:10.1097/scs.0b013e31827fef2c · Cited by 15
Ectopic bone formation during tissue-engineered cartilage repair using autologous chondrocytes and novel plasma-derived albumin scaffolds
Costales, D. R., Junquera, L. M., Pérez, E. G., Llames, S. G., Álvarez‐Viejo, M., & Meana, Á. (2016) · Journal of Cranio-Maxillofacial Surgery · doi:10.1016/j.jcms.2016.08.005 · Cited by 15
Anatomical variants of the superficial temporal artery in patients with microtia: a pilot descriptive study
Imran, F.-H., Yong, C. K., Das, S., & Yap, L. H. (2016) · Anatomy & Cell Biology · doi:10.5115/acb.2016.49.4.273 · Cited by 15
“The two most popular techniques in autogenous reconstruction of the microtic ear are those described by Brent [9] and Nagata [10].”
BackgroundMethod
Objective analysis of microtia reconstruction in Indian patients and modifications in management protocol
Sharma, M. K., Dudipala, R. R., Mathew, J., Wakure, A., Thankappan, K., Balasubramaniam, D., & Iyer, S. (2015) · Indian Journal of Plastic Surgery · doi:10.4103/0970-0358.163050 · Cited by 14
“Even though stainless steel wires had been used by Nagata and Firmin for a long time, we had resorted to the use of 4-0 polypropylene, 3-0 polydioxanone for suturing the framework components.”
BackgroundMethodInfluential
Reconstruction of auricular cartilage using tissue-engineering techniques
Rotter, N., Steiner, A., & Scheithauer, M. (2008) · Operative Techniques in Otolaryngology-Head and Neck Surgery · doi:10.1016/j.otot.2008.10.004 · Cited by 14
Total reconstruction of the burned auricle
Yamada, A., Imai, K., Nomachi, T., et al. (2006) · Burns · doi:10.1016/j.burns.2006.04.011 · Cited by 14
Rib Cartilage Assessment Relative to the Healthy Ear in Young Children with Microtia Guiding Operative Timing
Kang, S.-S., Guo, Y., Zhang, D., et al. (2015) · Chinese Medical Journal · doi:10.4103/0366-6999.162505 · Cited by 14
“Nagata[7] recommends that the operation not be performed on patients younger than 9 years owing to the smaller amount of rib cartilage available in younger children.”
Background
A New Microtia Reconstruction Method Using Delayed Postauricular Skin Flap
Li, G., Zhang, F., Ding, W., et al. (2017) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000003227 · Cited by 14
Correction of Lobule-type Microtia
Yotsuyanagi, T., Yamauchi, M., Yamashita, K., Yamada, T., Kato, S., Suzuki, A., & Saito, T. (2014) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000000136 · Cited by 14
“Background: Here, we introduce our recent operative technique for ear elevation that results in (1) minimal morbidity for patients, (2) symmetric appearance, (3) clearer 3-dimensional structure with a deep concha, (4) good aesthetic appearance by hiding the grafted area behind the ear, and (5) maintenance of deep temp…”
BackgroundMethod
Strategies for ear elevation and the treatment of relevant complications in autologous cartilage microtia reconstruction
Xu, Z., Li, Y., Li, D., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-17007-3 · Cited by 13
A new method using tissue expander makes auricular reconstruction easier
Yang, M., Jiang, H., Zhang, Y., et al. (2019) · Clinical Otolaryngology · doi:10.1111/coa.13304 · Cited by 13
Evaluation of the Usability of a Low-Cost 3D Printer in a Tissue Engineering Approach for External Ear Reconstruction
Kuhlmann, C., Blum, J. A., Schenck, T., Giunta, R., & Wiggenhauser, P. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms222111667 · Cited by 11
Subtotal reconstruction of the burned auricle
El-Khatib, H. A., Al-Basti, H. B., Al-Ghoul, A., et al. (2005) · Burns · doi:10.1016/j.burns.2004.09.022 · Cited by 13
Magnetic Resonance Imaging of the Ear for Patient-Specific Reconstructive Surgery
Nimeskern, L., Feldmann, E.-M., Kuo, W., Schwarz, S., Goldberg‐Bockhorn, E., Dürr, S., Müller, R., Rotter, N., & Stok, K. S. (2014) · PLoS ONE · doi:10.1371/journal.pone.0104975 · Cited by 13
“In autologous reconstruction, autologous cartilage is used to create a 3D cartilage framework that mimics the intact contralateral ear which is then implanted subcutaneously at the defect site [10,12–15].”
Method
Modified 2-Stage Method for Auricular Reconstruction
Ma, T., Xie, F., & Zhang, Z. (2018) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000001413 · Cited by 13
Comparison of three-dimensional and two-dimensional templates on auricle reconstruction in patients with unilateral microtia.
Fan, X., Niu, X., Wang, Y., et al. (2019) · PubMed · Cited by 13
Preclinical assessment of clinically streamlined, 3D‐printed , biocompatible single‐ and two‐stage tissue scaffolds for ear reconstruction
Brennan, J. R., Cornett, A. M., Chang, B., Crotts, S. J., Nourmohammadi, Z., Lombaert, I. M. A., Hollister, S. J., & Zopf, D. A. (2020) · Journal of Biomedical Materials Research Part B Applied Biomaterials · doi:10.1002/jbm.b.34707 · Cited by 13
Early Postoperative Complications in Microtia Reconstruction: An Analysis of the NSQIP‐P Database
Sharma, R. K., DeSisto, N. G., Ortiz, A. S., Landeen, K. C., Yang, S. F., Stephan, S. J., & Patel, P. N. (2023) · The Laryngoscope · doi:10.1002/lary.30989 · Cited by 12
Current Status of Auricular Reconstruction Strategy Development
Wei, Y., Li, L., Xie, C. H., et al. (2023) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000009908 · Cited by 12
A modified technique for firm elevation of the reconstructed auricle
Shan, J., Guo, Y., Chang, K. W., et al. (2016) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-016-3900-1 · Cited by 12
New Strategies for Remnant Ear Treatment in Lobule-Type Microtia Reconstruction
Xu, Z., Zhang, R., Zhang, Q., et al. (2018) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000004610 · Cited by 12
Recommendations for the Development and Reform of Microtia and Atresia Services
Mazeed, A. S., Saied, S. M. A., Abulezz, T. A., Youssef, G., & Bulstrode, N. (2019) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000005209 · Cited by 12
Onlay Rib Bone Graft in Elevation of Reconstructed Auricle: 17 Years of Experience
Kim, T., Han, J., & Lee, Y.-H. (2013) · Archives of Plastic Surgery · doi:10.5999/aps.2013.40.3.209 · Cited by 12
“The procedures in the first stage operation follow Nagata’s method [9-12].”
Sulcus Construction in Microtia Repair
Duvdevani, S. I., Magritz, R., & Siegert, R. (2012) · JAMA Facial Plastic Surgery · doi:10.1001/2013.jamafacial.7 · Cited by 12
Ovine Model for Auricular Reconstruction
Hohman, M. H., Lindsay, R. W., Pomerantseva, I., Bichara, D. A., Zhao, X., Johnson, M. A., Kulig, K. M., Sundback, C. A., Randolph, M. A., Vacanti, J. P., et al. (2014) · Annals of Otology Rhinology & Laryngology · doi:10.1177/0003489414523710 · Cited by 12
Anatomy of the superficial temporal artery in patients with unilateral microtia
Olcott, C. M., Simon, P. E., Romo, T., & Louie, W. (2018) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2018.09.001 · Cited by 12
Using an expanded scalp flap without fascial flap harvest or skin grafting for total auricular reconstruction in hemifacial microsomia with low hairline
Chen, Q., Wang, B., Wang, Y., et al. (2019) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2019.109726 · Cited by 12
The Application of Cartilage Tissue Engineering with Cell-Laden Hydrogel in Plastic Surgery: A Systematic Review
Wang, G., Zhang, X., Bu, X., An, Y., Bi, H., & Zhao, Z. (2021) · Tissue Engineering and Regenerative Medicine · doi:10.1007/s13770-021-00394-5 · Cited by 12
A new method for training of ear framework creation by silicon dental impression material
Thadani, S., & Ladani, P. (2012) · Indian Journal of Plastic Surgery · doi:10.4103/0970-0358.96614 · Cited by 13
“This is done with placing a surgical template[1-5] on sixth and seventh rib cartilage in such a way that whole of helical rim is placed on the cartilage except crus helicis [Figure 8].”
Method

Authors: Nagata, S.
Corresponding author: Nagata, Satoru
Venue: Plastic and Reconstructive Surgery
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1993-08
Volume: 92
Issue: 2
Pages: 187-201
ISSN: 0032-1052 (ISSN-L)
DOI: 10.1097/00006534-199308000-00001
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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A New Method of Total Reconstruction of the Auricle for Microtia

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