Auricular reconstruction of congenital microtia (grade III).
The auricular deformity of congenital microtia (Grade III) is almost always associated with congenital atresia, an affliction that can cause devastating physical and psychological trauma in children. Auricular reconstruction for congenital microtia (Grade III) should provide a child with a reasonable facsimile of an ear through a limited number of surgical procedures, with minimum complications. To achieve this result, the author developed the Integrated Auricular Reconstruction Protocol (IARP). The IARP consists of five stages: Stage I--framework construction and placement; Stage II--lobule creation; Stage III--atresia repair; Stage IV--tragal creation; and Stage V-auricular elevation. Over a period of 5.5 years, the author performed 188 surgical procedures on 63 patients, completing 31 ears. This thesis has four objectives. The first is to strongly recommend that a child with congenital microtia and atresia be seen as early as possible by both a plastic surgeon and an otologist. The second objective is to describe a protocol by which both defects can be corrected without endangering the integrity of either. The third objective is to advocate the involvement, from the very beginning, of not only the child but also the family--a critical but often over-looked component of the treatment of congenital microtia and atresia. The fourth and final objective is to propose that plastic surgeons interested in auricular reconstruction dedicate themselves to the performance of at least 10 such reconstructions per year.