Surgical Technique for Deep Concha, a Pseudomeatus, and High Projection in Congenital Auricular Reconstruction

Abstract

BACKGROUND: Despite successful cartilage framework construction and auricular elevation in 2-stage reconstruction, achieving adequate conchal cavity depth and auricular projection remains challenging. This study introduces a systematic third-stage refinement technique incorporating cartilage flap support, conchal excavation, and split-thickness skin grafting to address these aesthetic limitations. METHODS: Between January 2020 and December 2025, 127 patients with congenital microtia underwent 3-stage ear reconstruction. The technique comprised supraperiosteal tissue excavation to deepen the conchal cavity, vascularized cartilage flap support to enhance the auriculocephalic angle, and split-thickness skin grafting for coverage. Outcomes were assessed using Visual Analog Scale satisfaction scores, photographic analysis, and complication rates. RESULTS: After an average follow-up of 13.08 months (range: 6-60 mo), significant improvement in conchal cavity depth was achieved in all patients. Mean conchal depth increased from 4.53±2.55 mm preoperatively to 11.34±1.46 mm postoperatively (mean increase of 6.81 mm, P <0.001), resulting in enhanced projection and improved aesthetic outcomes. Patient satisfaction was high with a mean VAS score of 8.24±0.41 and 81.1% (103/127) rating satisfaction ≥8.0. The overall complication rate was 5.5% (7/127). One patient developed partial skin graft necrosis that healed by secondary intention within 3 weeks. No severe complications occurred. CONCLUSION: This novel technique effectively achieves a deep conchal cavity, a pseudomeatus-like structure, and enhanced auricular projection with high patient satisfaction and minimal morbidity.