Firm elevation of the reconstructed auricle with a retroauricular fascial flap wrapping an EH (a mixture of epoxide acrylate malelic and hydroxyapatite) composite wedge

Nagata's two-stage methods for ear reconstruction of congenital microtia have been widely used. In this study, we present another option to the second stage in Nagata's method. After the implanted auricle was separated from the bed, instead of using a temporoparietal fascial flap to wrap a cartilage wedge, we developed a new alternative using the retroauricular fascial flap wrapping an EH (a mixture of epoxide acrylate malelic and hydroxyapatite) composite wedge. In addition, it is quite often that, from a frontal view in the Chinese population, the upper and lower parts of the auricle are more prominent than the middle part. We designed an EH composite wedge with a special shape to obtain a firm elevation. Between July 2005 and June 2007, 117 patients underwent this operation; and the follow-up period ranged from 6 to 24 months, postoperatively. Among the 117 cases, the wedge was exposed only in one patient and hypertrophic scars were detected in two cases. Among the rest of the patients, there were no complications such as breakdown, exposure or infection. All the patients had satisfactory ear projection. This technique has the advantages of being straightforward and time saving. It is possible to create a firm elevation and to preserve the temporoparietal fascial flap and superficial temporal vessels for possible use in case of traumatic or secondary ear reconstruction in the future. Meanwhile, we clearly demonstrated that the EH composite wedge is a suitable material in the second stage of the reconstruction of the auricle. (C) 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.