ABSTRACT
Total auricular reconstruction of microtia with autogenous costal cartilage is one of the most demanding challenges in plastic and reconstructive surgery because of the complex three-dimensional shape of the auricle. An ideal result of the constructed ear depends primarily on the fabricated cartilaginous ear framework. As the cartilage framework used for reconstruction is always 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. For a configuration of the concha that is definitely anatomical, we constructed the conchal bowl element in one of three patterns according to the amount of available cartilages: one block, two-pieces, or a cymba bowl element only. The patients were followed up for more than 1 year. The aesthetic results were scored by evaluating characteristics involving the stability of the crus helicis, the conchal definition, and the smoothness of the helical curve.The ears reconstructed early without a conchal bowl element and ears reconstructed later with the concha bowl element showed a definite crus helicis, deep cymba conchal space, and smooth helical curve. The construction of the conchal bowl element is simple dan not time-consuming procedure. It is suggested that the conchal bowl element must be constructed and attached to the main framework for natural configuration of the reconstructed ear.