The Auricular Elevation Stage in Microtia Reconstruction

Abstract

Microtia is a congenital hypoplastic malformation of the pinna that can cause hearing impairment, cosmetic, and psychosocial problems. The auricular elevation in stage two is one of the most challenging procedures of autologous ear reconstruction. This article aims to determine whether the use of posterosuperior auricular fascia flap (PSFF), temporoparietal fascia flap (TPF), or retroauricular fascia flap (RFF) in stage 2 auricle reconstruction. A literature search was conducted in public databases and registries (PubMed/Medline, EBSCOhost, ProQuest, CENTRAL, ICTRP, Clinicaltrial.gov). Patients with unilateral or bilateral microtia were included in this study. The validity rating was assessed using the guideline from CEBM Oxford University. All these studies were analyzed for the systematic review of outcome studies of each surgical technique. PSFF is superior by reducing surgical time compared to RFF (p<0.01) with less risk of scarring (p=0.03) and less incidence of partial skin graft necrosis (p= 0.01). RFF offered superior aesthetic results compared to TPF. PSFF is a preferable technique for stage two reconstruction surgery in congenital microtia due to its ease of use, shorter operating time, and reduced complications compared to RFF. RFF may still be considered for better aesthetic outcomes, while TPF can be a suitable option in challenging cases.