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Abstract: Objective: To study the epidemiologic characteristics of microtia in China and to investigate the possible risk factors with respect to the classification of microtia. Methods: A total of 345 patients with microtia were studied. All patients were taken an intentional physical examination and classified into five types. A detailed questionnaire concerning the maternal conditions during pregnancy was filled out by patient''s mother. The frequencies of the relative factors were counted and the variables were statistically analyzed using Chi Square and Fisher''s tests in the five types of microtia. Results: Most cases of microtia (88.12%) were sporadic and 72.75% of all cases occurred in males. It was more seen unilateral, especially affected on the right side (55.94%). A total of 195 patients (56.52%) were isolated microtia. In the rest of non-isolated microtia patients, 37.97% of the cases had hemifacial microsomia, which was the most common associated deformity. Thirty-four patients (9.86%) belonged to typical familial microtia. Three maternal factors showed significant differences in the five types of microtia, which were perinatal virus infection, high prior miscarriages and prevention treatments for threatened abortion. Conclusions: The majority of microtia cases in China are sporadic and usually more common in males. Mothers who have prior miscarriages over 3 times or perinatal virus infection seem to be more likely to have severe microtia infants. [Copyright &y& Elsevier]

The base frame provides a stable support for the helix, antihelix, and tragus-antitragus complex in microtia reconstruction, and this support is vital to attain a highly defined outline for a reconstructed auricle. The success of base frame sculpting depends on appropriate treatment of the cartilage, mainly the sixth and seventh costal cartilages, which may have different characteristics. The aim of this study was to demonstrate the relevant details for base frame fabrication under various scenarios. Between 2016 and 2019, a total of 352 patients with microtia underwent autologous auricular reconstruction. Concerning the different sizes and characteristics of the costal cartilage used for the base frame reconstruction, we describe the related methods for fabrication and introduce corresponding strategies for proper management. We found that 90% of the patients responded at follow-up, and 76% of them were satisfied with the cosmetically refined auricle with harmonious integrity. The elaborate design and appropriate utilization of costal cartilage for base frame sculpting is one of the most significant and fundamental processes in microtia reconstruction. It contributes to achieving a clearly defined outline of the auricle with harmonious integrity, which is as important as the other projected subunits., (© 2021. The Author(s).)

Objectives: The retroauricular fascia flap (RFF) is one of the most commonly used vascularized linings for auriculocephalic sulcus reconstruction in staged total auricular reconstruction. This study aims to investigate the histomorphometric features regarding the retroauricular fascia., Methods: Histological evaluation included qualitative observation and quantitative analysis of sections of RFF stained with hematoxylin and eosin, Masson's trichrome, Elastica van Gieson, CD31, and Lyve-1. Ultrasonographic evaluation included measurement of the thickness of the superficial layer of the retroauricular fascia (RFF origin) at three different positions in microtia patients. P < 0.05 was considered statistically significant., Results: RFF was a thin, highly organized layer with mainly collagen fibers. From its superior to inferior portions, the percentage of collagen fibers differed significantly (superior 87.57 ± 10.85%, middle 68.29 ± 29.02%, inferior 53.31 ± 33.33%, p < 0.05). The percentages of elastic fibers in the superior (4.86 ± 5.17%) and middle (5.05 ± 5.37%) areas were higher than that in the inferior (2.14 ± 2.42%, p < 0.05). RFF blood vessel density (20× magnification) decreased significantly from the superior to inferior portions (superior 6.39 ± 1.18, middle 5.17 ± 1.15, inferior 2.67 ± 0.78, p < 0.05). Lymphatic vessel density (20× magnification) also decreased significantly from the superior to inferior regions (superior 6.80 ± 0.62, middle 5.26 ± 1.17, inferior 2.11 ± 0.46, p < 0.05). Thickness of the superficial layer of retroauricular fascia increased significantly from the superior to inferior regions (superior 0.29 ± 0.06 mm, middle 0.36 ± 0.09 mm, inferior 0.53 ± 0.14 mm, p < 0.001)., Conclusions: From cranial to caudal, the RFF became thicker, less elastic, and less vascularized, and contained fewer lymphatic vessels. Therefore, when the retroauricular fascia is large enough, the superior portion would be preferred for RFF in auriculocephalic sulcus reconstruction., No Level Assigned: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: Favorable results in auricular reconstruction are difficult to achieve. The authors report 350 patients with different types of microtia who underwent total ear reconstruction. The youngest was aged 5.5 years and the oldest was aged 50 years., Methods: The authors performed auricular reconstruction using autologous costal cartilage with the combination of the Brent and Nagata methods, with some modifications. At the first stage, an individualized framework fabrication based on different degrees of strength and thickness of the rib cartilages was performed. One piece of cartilage was added vertically under the reconstructed tragus to enhance conchal depth to provide a more prominent appearance. At the second stage, the elevated reconstructed ear was supported by bone cement with a special shape that was 2 mm wider at the end of two poles, giving the reconstructed ear more projection on the upper and lower poles. This external ear morphology occurs quite often in China., Results: In this series, the follow-up time in 322 patients ranged from 8 months to 6 years. Two hundred eighty-eight patients were satisfied with the results, including good shape, accurate size, right orientation, and duplication of more than 10 well-detailed structures. Surgery-related complications such as broken helix, skin necrosis, infection, blunted convolution, and extrusion of cartilage occurred in 13 cases and hypertrophic scars occurred in 21 patients., Conclusions: The authors' techniques produce acceptable results and fewer complications. This 6-year experience confirms the reliability, versatility, and reproducibility of this type of combined technique in auricular reconstruction, especially for Asian patients.