Surgical Complications in Microtia Reconstruction: An 11-Year Experience at an Academic Hospital in Surabaya, Indonesia

ObjectiveThis study evaluated the incidence, frequency, types, and risk factors of complications following staged autologous costal cartilage reconstruction for microtia at an academic hospital in Surabaya, Indonesia.DesignRetrospective descriptive study.SettingAcademic hospital in Surabaya, Indonesia, serving as a national referral center for microtia.ParticipantsMedical records of 122 unique patients with microtia who underwent autologous costal cartilage reconstruction between January 2014 and December 2024 were reviewed. Patients with incomplete records were excluded.InterventionsTwo-stage autologous microtia reconstruction using a costal cartilage framework. Stage-2 elevation was performed using either a temporoparietal fascia flap (TPF) or retroauricular fascial flap (RFF).Main Outcome MeasuresIncidence and type of postoperative complications involving the reconstructed ear, donor site, and neck.ResultsPostoperative complications occurred in 38 of 122 patients (31.1%), with 47 discrete complication events recorded. Complications were more frequent after stage 1 (27 events) than stage 2 (20 events). Stage-1 complications included skin necrosis (18.1%), cartilage exposure (9.0%), cartilage resorption (7.2%), and donor-site hypertrophic scar (5.4%). Stage-2 complications included skin necrosis (7.4%), synechiae (4.4%), auricular hypertrophic scar (4.4%), donor-site hypertrophic scar (7.4%), and wire exposure (1.4%). In stage 2, complications occurred in 25 of 57 TPF patients (43.8%), whereas no complications were observed in 10 RFF reconstructions.ConclusionsAutologous microtia reconstruction carries a notable complication risk, particularly after stage 1. Smoking, tissue quality, and flap selection may influence outcomes. Careful planning, counseling, flap selection, and postoperative care are essential to minimize complications and optimize results.