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Reconstruction of complex auricular malformations is one of the longest surgical technique to master, because it requires an extremely detailed analysis of the anomaly and of the skin potential, as well as a to learn how to carve a complex 3D structure in costal cartilage. Small anomalies can be taken care of by any plastic surgeon, providing that he/she is aware of all the refinements of ear surgery. In this chapter, we analyze retrospectively 30 years of auricular reconstruction, ranging from small anomalies to microtia (2500 cases), excluding aesthetics variants such as prominent ears., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Over the course of 12 months, a plastic surgical team from Paris, France, undertook 2 intensive ear reconstruction missions with plastic surgeons from the CoRSU Rehabilitation Hospital in Uganda. A cohort of over 30 adult women was assessed having been subjected to ear amputations by members of the Lords Resistance Army in Northern Uganda in the 1990s. The patients were identified, mobilized, and transferred to Kampala for surgery by a charitable arm of the Watoto Church, known as Living Hope. The surgical team performed 15 ear reconstruction cases during the first 1-week mission and 16 ear reconstruction cases during the second 1-week mission. All cases were reconstructed successfully using the 2-stage autologous auricular reconstruction method advocated by the senior author (FF). Local skin was used to cover the costal cartilage framework in the first stage without need for temporo-parietal fascial flaps. Technical challenges included the older age of patients and ossified costal cartilage, high prevalence of HIV positivity, bilateral amputation, and difficulty of surgical follow-up. The main modifications to standard practice were routine pre-op testing of the costal cartilage, pre-op viral load and CD4 count screening in HIV-positive patients, simultaneous bilateral first-stage ear reconstruction, prolonged hospital stay, and implementation of routine surgical counting procedures.

Background: The external ear is a complex, delicate structure and treatment of burned ears should not be neglected. We will detail the different scenarios a surgeon can encounter and present a therapeutic algorithm., Patients and Methods: From 1984 to 2011, we operated 134 patients for ear deformities secondary to burns, of which 90 cases were unilateral (67%) and 44 cases bilateral (32%), accounting for 178 ear in total. Our two-stage technique is based on an autologous cartilage framework, covered by mastoid skin, superficial temporal fascia (STF) or indirect skin expansion, and later by elevation of the construct., Results: Costal cartilage is the ideal support when loss of substance is greater than one quarter of the ear pavilion and/or two plans. Mastoid skin integrity is the best factor of prognosis when planning an ear reconstruction. If injured, the STF can be used. If the STF has been injured as well, indirect expansion represents the last option before placement of prosthesis. Free contralateral STF is rarely an option in these patients, although it should be considered., Conclusion: Reconstruction of one or both ears is often the last step in a rehabilitation process after burns. It is ideally performed after wound healing has been achieved, and by a team well trained in microtia treatment and post-traumatic reconstruction., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Ear reconstruction is considered to be a challenging form of surgery. In cases of microtia, surgeons must reconstruct complex missing contours, which necessitates the use of a support and skin remnants to cover this support. Although the use of synthetic material has been proposed in order to avoid harvesting and carving cartilage, the best long-term choice for reconstructing an ear is autologous rib cartilage. This procedure requires good understanding of the 3-dimensional architecture of the ear and learning the step-by-step construction of a harmonious framework (which with practice will become the most straightforward part of the procedure). Surgery, usually performed at the age of 9 or 10 years, is planned in 2 stages. In the first stage, the framework is placed under a skin pocket. Six months later, the sulcus is created using an additional cartilage graft for projection and a skin-grafted galeal fascial flap. In order to shorten the learning curve, a detailed carving process is described here, as well as a tool to enable training before surgery. Remnants of the microtic ear can have many different shapes; therefore, a comprehensive approach to skin management is proposed, providing a simple surgical classification for all types of microtia. Furthermore, some refinements of the cartilage framework and the construction of the retroauricular sulcus have improved results. Whenever possible, successful reconstruction of a microtic ear with autologous rib cartilage, as opposed to synthetic materials, is by far the best option., (Copyright 2010 S. Karger AG, Basel.)

Background: Correction of prominent ears is one of the most common operations performed in congenital deformity. Many appropriate corrective techniques have been described. While rare, severe complications destroying ear contours can occur and their correction should follow the established principles of ear reconstruction., Methods: A retrospective review of the notes of all patients who presented to Clinique George Bizet (1981-2007) in Paris, for correction of complications after undergoing prominent ear surgery at another facility, was performed. Each patient's age, gender, diagnosis, number of previous operations and final outcome were noted as available. Patients were included in this study if they had undergone one or more operations for prominent ears, leading to severe destructive complications, prior to consultation with the senior author and then underwent surgical repair with either an auricular (conchal) cartilage graft or with autogenous costal cartilage., Results: A total of 49 (25 female, 24 male) patients met the inclusion criteria. The mean age at presentation was 23 years (range of 10-59 years of age). The mean number of previous attempts to correct the ear deformity was 1.3 (1-12) times. Eight patients underwent reconstruction with a conchal cartilage graft and 41 with costal cartilage., Conclusions: While more minor contour deformities are correctable with a contralateral conchal cartilage graft, when more than a quarter of the ear or more than two planes of its complex folds are deformed, costal cartilage is recommended for surgical repair. The principles of ear reconstruction should be well understood prior to attempting a repair of severe complications after otoplasty.

In the correction of microtia, whether it be isolated or associated to other facial anomalies, the same principles are followed: sculpture of a framework from autologous rib cartilage to reproduce the contours of an ear and coverage of the framework with the cutaneous remnants. The sculpting of the cartilaginous framework requires sufficient training which through experience becomes the most routine surgical step of the reconstruction. Regarding the cutaneous step, it is different, because the microtia may appear in multiple forms. Numerous clinical classifications have already been published. The new classification which has been proposed, enables a better understanding of the cutaneous step of microtia correction. It is a surgical classification. Three different types of skin plasties (type 1, 2 and 3) allow for the treatment of all microtia. Thus, a surgical proposal can be advocated as early as the clinical examination regarding the appropriate utilization of the cutaneous remnants.

The technique of reconstruction of a microtia, observed in cases of otomandibular dysplasia, does not differ in its principle from that of an isolated microtia. The technical approach depends primarily on the aspect of the auricular remnants whose forms are multiple and are in no way etiologically specific. However, when associated with other malformations of otomandibular dysplasia, the microtia presents some particularities and its correction must be integrated in the global treatment of hemifacial anomalies.

The aim of this paper is to report my experience of 352 ear reconstructions to correct microtia with Brent's technique (n = 184) and Nagata's technique (n = 144). The remaining 24 were atypical presentations reconstructed in a one-stage procedure. Brent's technique is a safe, step-by-step, four-stage reconstruction and Nagata's technique involves only two stages. Nagata's innovations include transposing the lobule of the auricle during the first stage, carving a framework that includes the tragus, and constructing the posterior wall of the concha during the second stage. Cases of typical microtia have been selected to illustrate the advantages and pitfalls of both techniques.

In this paper we introduce the use of a subgaleal flap to construct the auditory canal in cases of microtia associated with aural atresia. The anatomy, the vascularisation, and the nomenclature of the different planes that constitute the temporal region are wellknown. The subgaleal fascia, also referred to as the loose areolar fascia has been until now the less surgically exploited of these planes. Nevertheless, it has a structure and a vascularisation that enables it to be dissected and used surgically. The subgaleal flap used to line the neoauditory canal drilled into the bone provides a vascular bed that greatly improves the quality of the skin graft and supports the tympanoplasty. The procedure is done while the ear is being raised, which constitutes the second stage of the two-stage ear reconstruction. This new approach has been used on 22 ears. A preliminary analysis of the results shows that construction of the auditory canal has been improved.

Pessimism about the results of surgical reconstruction of the pinna in cases of microtia is unjustified. Currently there are two techniques available which give excellent results if conditions are favourable: these are the techniques of Brent and of Nagata. This article describes both of these techniques, whose common principle is the use of autologous costal cartilage sculptured to give the contour of a normal ear, and the areas where they are different. The author has carried out 154 reconstructions using the Brent technique and 92 using the Nagata technique, and gives a critical analysis of the results obtained by these two methods.

By recalling the imperatives of auricular reconstruction, the author analyses the indications for tissue expansion in this area. This expansion can be performed preoperatively or intraoperatively, directly on the ear, indirectly, away from the ear. In the light of his experience, illustrated by three clinical cases, the author considers preoperative indirect expansion to be the most useful, by placing the expander underneath the scalp.

Reconstruction of an ear destroyed by burns raises several difficulties related to the presence of associated lesions. The essential element determining the indication for reconstruction is the possibility to cover a three dimensional cartilaginous graft with skin. Depending on the local condition of the skin, retroauricular skin, a temporal fascia flap or preliminary expansion may be indicated. Reconstruction should be performed when the chances of obtaining a good result are sufficient in a motivated patient. If these conditions are not satisfied, prosthesis should be proposed.

Personally trained by Burt Brent, the author reports her experience based on 143 total reconstructions of the external ear, 92 of which were performed to correct microtia. The principles of the technique and the refinements introduced by Burt Brent are described. After analysing the various clinical features of microtia, the author presents the results which demonstrate the considerable contribution of this technique to total reconstruction of the external ear.