Background and objective.

The key to the success in auricular reconstruction relies in two equally important pillars: coverage and structure of the new ear. Costal cartilage is the material of choice due to its autologous nature. It can be placed directly under the vascularized and supple native skin of the microtic remnant and adjacent mastoid region and it´s available in large quantities to reproduce the complex spatial structure of an ear, with minimal sequelae at the donor site. It is flexible, yet rigid enough to withstand the forces of contraction during healing, maintaining its shape in the long term. The surgeon must practice exhaustively to learn the framework carving, because the end result will rely mostly in the quality and details of the cartilage ear.

In this paper we describe a step- by- step surgical technique, in the aim to simplify the task for surgeons who are learning their first steps in auricular reconstruction, and explain some technical details for more experienced surgeons, in order to give the future ear the best coverage possible: the native skin, which should never be discarded and replaced for a coverage of less quality to favor the placement of an alloplastic material.

Methods.

We describe the appropriate age for surgery, the necessary preoperative studies, the types of auricular frames, the surgical technique step by step: preparation of the molds, taking of the rib cartilage, carving of the model and postoperative cares.

In addition, we present our casuistry between 2011 to 2020.

Results.

We made 196 frameworks in patients between 10 and 57 years of age; 75.51% (148 cases) virgin microtias, and 24.4% (48 cases) secondary cases, of which in 46% (22 cases) we used local skin and in 54% (26 cases) a flap of temporo-parietal fascia plus skin graft.

The type of frame used was complete (Firmin Type 1) in 90.81% (178 cases), without antitragus or tragus (Firmin Type 3) in 5.10% (10 cases) and without antitragus (Type 4) in 2.04%. (4 cases). In 4 patients (2.04%) we used the Type 1c frame.

Complications were rare, and preferably (15%) in the form of hypertrophic scars.

Conclusions.

In auricular reconstruction, a refined technique is essential and avoiding alloplastic materials, which sacrifice native skin coverage. For this, we present in detail the carving of the model, we describe maneuvers to minimize the pain resulting from cartilage harvesting, and we present a modification to the Firmin framework classification.

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