Clinical Fellow/Instructor Vanderbilt University Medical Center, Tennessee
Background: Tragal reconstruction during single-stage porous high-density polyethylene (pHDPE) microtia repair can be a challenging component of surgery. Decisions regarding formation of the tragus must consider the status of the ear canal, the type of pHDPE implant used, and the availability of cartilage and soft tissue for tragus formation. Learning Objectives : Understand the options and considerations for tragal reconstruction in patients undergoing single-stage pHDPE microtia repair. Study Objective: Describe the surgical techniques and outcomes of tragus formation with either pHDPE or auricular cartilage during single-stage pHDPE microtia repair. Design Type: Case series Methods: We present a case series wherein patients underwent tragal reconstruction during pHDPE microtia repair. In some cases, the tragus was constructed from pHDPE as part of a custom pHDPE implant. This option was not feasible in the setting of simultaneous atresiaplasty because the fascial layer required to cover the pHDPE implant does not reach across the newly formed ear canal. Another option was tragal formation from remnant auricular cartilage with local flap coverage. The feasibility of this technique depended upon the availability of cartilage and excess skin from the microtic ear. Similar considerations were given to pHDPE microtia repair with standard 2 piece implant reconstructions. Results: Tragal constructs of adequate size and stability were formed from both pHDPE and auricular cartilage. Conclusion: Our case series highlights the essential considerations for successful tragus formation in pHDPE microtia repair.