Single-Stage Autologous Microtia Reconstruction

Microtia reconstruction using autologous costal cartilage is one of the most challenging procedures in plastic surgery, offering long-term durability and biocompatibility. The Nagata 2-stage autologous technique involves creation of a soft tissue pocket and auricular framework from costal cartilage in the first stage, then projection of the framework in the second stage using a temporoparietal fascial flap and skin graft. However, the second stage compromises the aesthetic result due to skin graft color mismatch, edema, and contracture, while also eliminating the TPF flap as a future salvage option. Consequently, the authors present a single-stage autologous technique for microtia reconstruction with several modifications to the Nagata technique: (1) elevating the framework using a projecting block within a single stage, (2) performing wider undermining of the soft tissue pocket to accommodate this elevation, (3) adding a cranial extension to the tragus for stability, and (4) refining the contour of the inferior crus. In a series of 40 consecutive cases using the single-stage technique, our surgical complication rate was 15%, comparable to rates reported for autologous reconstruction. The single-stage approach yields reliable aesthetic and functional outcomes and maintains future revision options, making it an effective alternative for microtia reconstruction.