Evaluation of Techniques and Outcomes in Pediatric Partial Ear Reconstruction: A 15-Year Experience.

Abstract

Partial ear reconstruction of large defects challenges surgeons to blend native and reconstructive auricular structural and soft tissue segments while preserving natural ear contours, accommodating variable etiologies and anatomical involvement. For pediatric patients, consideration of skin coloration, scar location and visibility, readiness for surgery, and compliance with postsurgical care contribute heavily to what is considered a successful outcome. This study reviews our institutional experience with techniques to manage large partial auricular defects in pediatric patients who did not elect for total ear reconstruction. This is the largest reported cohort of any-cause pediatric partial ear defects in the literature. A retrospective review was conducted of pediatric patients who underwent partial ear reconstruction of large or structurally significant defects between 2009 and 2024. Patients were categorized based on etiology (acquired or congenital). Demographics, operative details, and outcomes were collected. Eighteen ears from 17 patients were included, comprising 9 acquired (50%) and 9 congenital defects (50%). The average time from injury to surgery was 2.9 ± 3.2 years. Most defects involved the upper third of the ear (n = 14, 77.8%). All ears underwent autologous costal cartilage reconstruction. Seven cases had inadequate local tissue (acquired = 5; congenital = 2); of those, 6 underwent temporoparietal fascia flap (TPFF) coverage (acquired = 4; congenital = 2), and 1 underwent tissue expansion due to concurrent injury to the ipsilateral temporoparietal fascia region (acquired). Local tissue was used for coverage in 12 cases (acquired = 5; congenital = 7). One framework exposure and one explantation occurred in the acquired cohort. The average follow-up duration was 2.5 ± 2.0 years. At our institution, large partial ear defects require comprehensive discussions with patients and families regarding optimal approaches while addressing individual priorities and limitations. Our evolved structural approach using autologous costal cartilage reconstruction demonstrated reliable outcomes in large pediatric partial ear defects of any indication (congenital or acquired). We consider TPFF early in traumatic scenarios that have missing or poor-quality skin, or congenital presentations where skin is tethered, fixed, or unable to fully unfurl.