BACKGROUND: Total auricular reconstruction of microtia with autogenous costal cartilage poses one of the most demanding challenges in plastic and reconstructive surgery because of the unique and complex three-dimensional shape of the auricle. Attaining an ideal result of the constructed ear depends primarily on the fabricated cartilaginous ear framework. In this article, the authors discuss the essential modifications of ear framework grafting. The authors elaborate the relevant anatomical details for a harmonious ear framework and present a favorable result of the contour of the reconstructed auricle. METHODS: Fabricating the auricular framework corresponds roughly with Brent's method. As the cartilage framework used for reconstruction is always imperfect or insufficient for the fabrication of anatomical structures, especially the tragus and the conchal bowl, individualized framework grafting based on different patient age groups and different degrees of strength and thickness of the rib cartilages have been devised accordingly. RESULTS: A total of 126 patients underwent reconstruction using autogenous costal cartilage between 2007 and 2008. Three cases performed with the new modification of the framework fabrication are shown. They reveal that a harmonious ear framework was achieved and presented a reconstructed auricle with a favorable result. Surgery-related complications occurred in four cases. CONCLUSIONS: Consequently, individualized framework fabrications are useful in every case and the cartilaginous cube fastened under the constructed tragus is proving to keep the tragus in a stable and erect position. Therefore, the modifications allow one to attain a harmonious ear framework and satisfactory three-dimensional outline of the auricle.
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