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Original Investigation |

Modular Component Assembly Approach to Microtia Reconstruction

Jessica R. Gandy, BS1,2; Bryan Lemieux, BS1,2; Allen Foulad, MD2,3; Brian J. F. Wong, MD, PhD2,3,4,5
[+] Author Affiliations
1Medical student, School of Medicine, University of California–Irvine, Irvine
2Beckman Laser Institute and Medical Clinic, University of California–Irvine, Irvine
3Department of Otolaryngology, Head and Neck Surgery, University of California–Irvine, Orange
4Department of Otolaryngology, Head and Neck Surgery, University of California–Irvine, Irvine
5Department of Biomedical Engineering, University of California–Irvine, Irvine
JAMA Facial Plast Surg. 2016;18(2):120-127. doi:10.1001/jamafacial.2015.1838.
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Background  Current methods of microtia reconstruction include carving an auricular framework from the costal synchondrosis. This requires considerable skill and may create a substantial defect at the donor site.

Objective  To present a modular component assembly (MCA) approach that minimizes the procedural difficulty with microtia repair and reduces the amount of cartilage to a single rib.

Design, Setting, and Participants  Ex vivo study and survey. A single porcine rib was sectioned into multiple slices using a cartilage guillotine, cut into components outlined by 3-dimensional printed templates, and assembled into an auricular scaffold. Electromechanical reshaping was used to bend cartilage slices for creation of the helical rim. Chondrocyte viability was confirmed using confocal imaging. Ten surgeons reviewed the scaffold constructed with the MCA approach to evaluate aesthetics, stability, and clinical feasibility. The study was conducted from June 5 to December 18, 2014.

Main Outcomes and Measures  The primary outcome was creation of a modular component assembly method that decreases the total amount of rib needed for scaffold construction, as well as overall scaffold acceptability. The surgeons provided their assessments through a Likert-scale survey, with responses ranging from 1 (disagree with the statement) to 5 (agree with the statement). Thus, a higher score represents that the surgeon agrees that the scaffold is structurally and aesthetically acceptable and feasible.

Results  An auricular framework with projection and curvature was fashioned from 1 rib. The 10 surgeons who participated in the survey indicated that the MCA scaffold would meet minimal aesthetic and anatomic acceptability. When embedded under a covering, the region of the helix and antihelix of the scaffold scored significantly higher on the assessment survey than that of an embedded alloplast implant (mean [SD], 4.6 [0.97] vs 3.5 [1.27]; P = .007). Otherwise, no significant difference was found between the embedded MCA and alloplast implants (4.42 [0.48] vs 3.87 [0.41]; P = .13). Cartilage prepared with electromechanical reshaping was viable.

Conclusions and Relevance  This study demonstrates that 1 rib can be used to create an aesthetic and durable framework for microtia repair. Precise assembly and the ability to obtain thin, uniform slices of cartilage were essential. This cartilage-sparing MCA approach may be an alternative to classic techniques.

Level of Evidence  NA.

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Figure 1.
Diagram of Experimental Rib Harvest and Experimental Design

A, Fifth porcine costal cartilage after removal of surrounding soft tissue. The ruler is in inches (to convert to centimeters, multiply by 2.54). B-C, Several slices measuring 1 to 2 mm thick obtained from the cartilaginous rib. D-F, A 2-mm-thick slice curved for the helical rim using electromechanical reshaping (EMR). A cylindrical cork jig was used to maintain the cartilage in a curved position during EMR. UC indicates University of California.

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Figure 2.
Three-Dimensional (3D) Printed Plastic Templates Used in Cartilage Shaping and Assembly

A-C, Three 1-mm-thick slices of cartilage were cut into shape with the templates to create the main base. D and E, Next, the conchal bowl was created using two 1-mm-thick slices of cartilage that were sutured together perpendicularly and then sutured to the main base to create the 3D projection of the conchal bowl. F and G, The helical rim was assembled using one 2-mm-thick slice (F) and one 1-mm-thick slice (G) of cartilage and was sutured perpendicularly to the foundation cartilage. H and I, The helix, including the helical crura, was created using 2 pieces of cartilage overlaid on top of the foundation cartilage and secured with sutures. J, A thick residual segment of cartilage was secured to the inferiormost portion of the scaffold to form the antitragus. K, A 3D printed scaffold was created to aid in reproducibility and better understanding of the assembly process.

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Figure 3.
Diagram of the Cartilage Scaffold Assembly

The scaffold was created in a stepwise approach using the 3-dimensionally (3D) printed plastic jigs as a guide. Plastic templates were designed and 3D printed to streamline the cartilage scaffold construction process. Cartilage pieces were cut into their respective shapes and sutured together.

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Figure 4.
Specimens Evaluated by Surgeons to Determine Scaffold and MCA Approach Feasibility and Acceptability

A, Autologous auricular scaffold made from the MCA method (ear A). B, Modular component assembly autologous scaffold covered by a clay mold (ear B). C, Alloplast scaffold covered by a clay mold (ear C). The ruler is in inches (to convert to centimeters, multiply by 2.54).

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Figure 5.
Scaffold Projection

Lateral and straight-on views of the scaffold demonstrating adequate lateral projection. A, Straight-on view of the scaffold. B, Lateral view of the scaffold. The ruler is in inches (to convert to centimeters, multiply by 2.54).

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