Total auricular reconstruction with a three-dimensional costal cartilage framework.

Microtia (hypoplasia of the auricle) is known to result from incomplete development of the auricle during embryonic development so that the size and shape of the deformity vary from case to case. Total auricular reconstruction for microtia is dependent on the degree of hypoplasia in comparison to that of the normal auricle on which the specific reconstruction method is based. I have classified microtia into 3 major types: 1) The lobule type. 2) The concha type, and 3) The small concha type which has been previously described [32]. Regardless of the size and shape of the deformity, the ultimate goal of total reconstruction of the auricle consists of construction of an auricle with an appearance as close as possible to that of a normal auricle. With this objective in mind, total reconstruction of the article is a science and not just a form of art as frequently considered. If it is only an art, the constructed auricle is greatly influenced by the artist's individuality and by the observer's. Thus, as a reconstructive plastic surgeon, the final outcome or result of total reconstruction of the auricle is that the constructed auricle should resemble as closely as possible the normal auricle, regardless of the observer and without any personal influence of the surgeon. I therefore consider total reconstruction of the auricle to be a field of science attained by numerous refinements and modifications in the procedures and techniques [33-36] and not just a simple form of art. The auricle constitutes only a small portion of the total body surface area, but it is probably one of the most complicated and/or sophisticated morphological structures of the body. It is necessary to fully understand the three-dimensional (3-D) morphological properties of the auricle and to pursue the ultimate goal of reconstructing an everlasting auricle as to the normal auricle. In other words, the constructed close as possible auricle must not be a sculptured object or structure, but is a living structure. A healthy constructed auricle is lasting and alive. Follow-up studies must be performed with strict standards and evaluation criteria in order to determine whether or not a reconstructed auricle is healthy.