Influence of vascular anatomy and perfusion on complications in the first stage of total auricular reconstruction.

Abstract

The aesthetic quality of total auricular reconstruction for microtia has improved significantly in recent years, resulting in favourable outcomes for many patients. However, complications such as skin necrosis and infection remain. Adequate skin perfusion is essential to prevent these complications, but the vascular anatomy of patients with microtia is poorly understood. We evaluated the relationship between vascular anatomy assessed by indocyanine green fluorescence angiography performed during the first stage of autologous total ear reconstruction for microtia and postoperative complications. Fifty patients with microtia undergoing autologous total ear reconstruction and intraoperative indocyanine green fluorescence angiography were prospectively enroled from October 2020 to December 2021. Postoperative complications, including skin necrosis and infection, were determined from photographs taken one week postoperatively. Of the 50 patients, 39 had lobule type microtia and 11 had concha type microtia. Fourteen patients had skin necrosis, 2 of whom required revision surgery due to infection. These 2 patients did not have subcutaneous pedicle perforators. Indocyanine green fluorescence angiograms showed subcutaneous pedicle perforators in 80% of patients. Modified Poisson regression analysis revealed that sex, subcutaneous pedicle perforator, three-branch score, and microtia type were associated with skin necrosis ≥20 mm². The extent of skin necrosis may be influenced by the presence or absence of subcutaneous pedicle perforators and the subdermal vascular plexus in the first stage of autologous total ear reconstruction for microtia. Females and patients with concha type microtia require more attention to avoid skin necrosis.