Reconstruction of acquired sub-total ear defects with autologous costal cartilage

Acquired sub-total ear defects are common and challenging to reconstruct. W e report the use of an autologous costal cartilage framework to reconstruct sub-total defects involving all anatomical regions of the ear. Twenty-eigh t partially damaged ears in 27 patients were reconstructed with this techni que. The defects resulted from bites (14), road traffic accidents (five), b urns (four), iatrogenic causes (four) and chondritis following minor trauma (one). Computerised image analysis revealed a median of 31% (range 13-72%) ear loss. An autologous costal cartilage framework was fashioned in all ca ses. If adequate local skin was,available, this was draped over the framewo rk, but in nine cases preliminary tissue expansion was used and in a furthe r three cases with significant scarring, the framework was covered with a t emporoparietal fascial flap. Clinical assessment after ear reconstruction was undertaken, scoring for sy mmetry, the helical rim, the antihelical fold, the lobe position and a 'nat ural look' to produce a four-point scale, 11 were excellent, 12 were good, two were fair and three were poor. Our experience suggests that formal dela yed reconstruction with autologous costal cartilage is to be recommended wh en managing acquired, sub-total ear deformity.