"Bio-Hammock" technique for prevention of expander inferior displacement in auricular reconstruction: A retrospective comparative cohort study of 198 patients.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 42679423.
- Also identified by DOI 10.1016/j.bjps.2026.08.015.
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Abstract
Inferior displacement of tissue expanders during first-stage auricular reconstruction remains a persistent clinical challenge. We evaluated a modified dual-plane "bio-hammock" technique, in which the inferior pole of the expander (approximately 1.5-2.0 cm) is embedded within an intramuscular pocket fashioned within the sternocleidomastoid muscle (SCM) belly, because of its efficacy in preventing inferior displacement and reducing complications. A retrospective cohort study was conducted on 198 patients with unilateral microtia who underwent first-stage expander implantation between January 2022 and December 2025. The modified dual-plane cohort (n=99) was treated using the modified dual-plane technique and conventional single-plane cohort (n=99) was treated using the conventional single-plane technique. All expanders (80 ml) were over-inflated to approximately 110 ml (137.5% of nominal volume). The primary outcome was inferior displacement distance prior to the second-stage procedure and secondary outcomes included complication rates, VAS pain scores, and patient satisfaction. Inferior displacement was significantly reduced in the modified dual-plane cohort compared with the conventional single-plane cohort [median 0.30 (IQR: 0.22-0.38) cm vs. 1.40 (IQR: 1.15-1.70) cm; P<0.001], representing a 78.6% reduction. The overall complication rate was 2.0% vs. 7.1% (P=0.170), with zero expander exposure in the modified dual-plane cohort vs. 4.0% in the conventional single-plane cohort (P=0.121). Early postoperative VAS scores were marginally higher in the modified dual-plane cohort; however, they normalized by postoperative day 7. The "bio-hammock" technique provides superior mechanical stability against gravitational inferior displacement under extreme over-inflation conditions, with a favorable safety profile including zero expander exposure. This technique represents a safe and effective refinement for first-stage auricular reconstruction.