Introduction: Auricular reconstruction with autologous cartilage has become well established in the last decade. By optimizing the technique, both the results and reliability have improved.
Operation and results: Based on our experience with 120 cases, we developed a concept that allows total ear reconstruction in two surgical steps. In the first operation, autologous rib cartilage is harvested and a natural framework created following the template of the opposite ear. The ear remnant is transposed and the framework placed in a subcutaneous pocket on the mastoid plane. After a healing period of around 6 weeks, the second operation reconstructs the auricular projection and the postauricular fold. The surgical procedure has to be adapted to difficult soft tissue situations. Most important is the specific analysis of local tissue and its resulting limitations. Deep scaring and skin grafting from previous operations need coverage of the framework with a subgaleal fascia flap.
Conclusion: This optimized and adapted surgical procedure allows auricular reconstruction with autologous rib cartilage from the age of around 8 years into old age with good, reproducible results.