Using the traditional sequence of reconstruction with microtia repair first, the external ear can retract into the newly formed canal. Surgeons following the traditional sequence insert the cartilage graft first and allow this to heal. Canalplasty is then performed at the appropriate time during the standard staged microtia repair. Following meatoplasty, the surgeon sutures the canal split-thickness skin graft to the tissue edge of the reconstructed auricle created by the meatoplasty (Illustration A). We hypothesize that as the canal skin graft heals, it can retract or shift creating tension on the auricular reconstruction. This tension causes deformity of the reconstructed auricle with noticeable change in position and shape as evidenced by folding of the skin and change in overall shape (Illustration B). By reconstructing the canal before beginning the external ear reconstruction, this complication is avoided because the canal split-thickness skin graft heals before the microtia reconstruction even begins.

Pen and ink illustration modified using Photoshop 5.5.

For David Hamlar, MD, DDS; Department of Otolaryngology, Head and Neck Surgery, University of Minnesota; Minneapolis Minnesota.

Illustration presented at the Combined Otolaryngology Spring Meetings 2001 by: Walsh WE Jr, Roy S, Levine S, Hamlar DD. The Sequence of Atresia Repair and Microtia Reconstruction. COSM; Palm Desert, California; May 2001. Presentations

Illustration submitted for publication in: Walsh WE Jr, Roy S, Levine SC, Hamlar DD. The Sequence of Atresia Repair and Microtia Reconstruction. Archives of Facial Plastic Surgery (submitted). Publications

© 2001, Bill Walsh.