Primary Ear Reconstruction Using Cadaveric Costal Cartilage

Abstract

Objective Allogeneic cadaveric costal cartilage is commonly used for grafts in nasal reconstruction surgery; however, limited information exists on its use in total ear reconstruction for microtia. In this case series, we describe the novel use of cadaveric cartilage for auricular framework construction in ear reconstruction and review preliminary histologic findings. Methods Patients requiring primary complete reconstruction of the auricle from August 2020 to December 2021 were eligible and underwent ear reconstruction using cadaveric costal cartilage. Patients were evaluated for surgical site infection, skin necrosis, cartilage resorption, and cartilage exposure during regular follow-up visits. Two cartilage samples were taken after 2 separate second-stage surgeries done 52 weeks after first-stage reconstruction. These samples were stained with hematoxylin and eosin as well as safranin-O and examined under light microscopy. Results A total of 12 ear reconstruction procedures using cadaveric costal cartilage were performed across 11 patients; 10 of 12 ears had type III microtia and 2 of 12 ears had type IV microtia. Patients ranged from 4 to 25 years old at the time of surgery, with an average age of 10.7 years. Follow-up time ranged from 1.6 to 25.4 months, with a mean follow-up time of 11.2 months. No patients experienced any visibly significant cartilage warping. Two patients experienced minor construct exposure, which were successfully salvaged. Two patients experienced surgical site infections, one lead to resorption requiring framework replacement. Preliminary histologic analysis of the 2 samples taken 1 year after implantation showed viable chondrocytes with no evidence of immunologic rejection or any local inflammation or host foreign body response. Conclusions Cadaveric costal cartilage serves as a viable alternative to autologous cartilage and other alloplastic biomaterials for construction of auricular frameworks in primary microtia reconstruction. Resorption secondary to infection and construct exposure remain potential risks. Longer follow-up times and a larger sample size are needed for assessment of long-term efficacy.