Objective To introduce and analyze a new method to handle refractory air leakage in auricle reconstruction with the modified Nagata method. Methods From September 2015 to 2018, a total of 1 228 patients with microtia (1 286 affected sides) received Nagata auricle reconstruction. Continuous negative pressure suction was applied to maintain the reconstructed auricle morphology postoperatively. Three different treatments were given according to the degree of severity of air leakage: (1) Refined suture of the incision; (2) Covering the sutured incision with Vaseline or erythromycin ophthalmic ointment; (3) Sealing the sutured incision with dermabond. Finally, the level of negative pressure was adjusted according to the tension and blood supply of the posterior auricular flap. Results In all 1 228 patients, Vaseline or erythromycin ophthalmic ointment were used in 283 sides and dermabond was used in 84 sides. Negative pressure of all incisions maintained well postoperatively and no air leakage reoccurred. A total of 73 patients underwent negative pressure adjustment because of blood supply disturbance of the flap postoperatively. Among them, 2 patients experienced flap necrosis and cartilage exposure, but finally healed by transplantation and cover of temporal fascia flap and free skin graft. The other reconstructed auricles had realistic contours and a satisfactory appearance. No complications such as ecchymoma, effusion, or delayed healing of incisions occurred. Conclusion The application of dermabond and a negative pressure device can efficiently and safely resolve refractory air leakage in auricle reconstruction with the modified Nagata method, so as to obtain clear and realistic contours. [ABSTRACT FROM AUTHOR]