Aesthetic Plastic Surgery

, Volume 42, Issue 6, pp 1556–1564 | Cite as

Aesthetic Auricular Reconstruction in Adult Patients with Rib Cartilage Calcification Using a Modified Two-Step Technique

  • Wenshan Xing
  • Yue Wang
  • Jin Qian
  • Bingqing Wang
  • Xu Zhou
  • Tun Liu
  • YongBiao Zhang
  • Qingguo ZhangEmail author
Original Article Facial Surgery



It is very important for congenital microtia patients to achieve better aesthetic appearance, craniofacial balance and mental health through auricular reconstruction. But there are great challenges for plastic surgeons on how to perform this technique in adult patients with tough and rigid rib cartilage because of the different extent of calcification. To lower the harvest of the cartilage and reduce the suffering during the operation, in this study, we report a modified two-step method for adult patients who suffered rib cartilage calcification in auricular reconstruction.


From January 2012 to January 2018, 89 adult patients (aged from 24 to 50) with cartilage calcification were enrolled and received auricular reconstruction using the modified two-step technique. The whole procedure was performed in two surgical stages. In the first stage, rib cartilages were harvested and modified cartilage frameworks were designed, fabricated and grafted, which included an ear-shaped framework and a C-shaped base part. The ear-shaped framework was inserted into the mastoid region through a W-shaped incision, but the C-shaped base part was embedded subcutaneously in the donor site. In the second stage, the C-shaped base part was transplanted into the mastoid region to elevate the reconstructed ear. A retro-auricular fascia flap and a free skin graft were used to cover the posterior side of the reconstructed ear.


The patients were followed for 6 to 24 months. During the follow-up visiting, 80 cases (89%) were satisfied with the outcomes in size, shape, location and details of reconstructed ears.


Our modified technique is safe and effective for auricular reconstruction, reduces the harvest of cartilage and decreases the suffering as well in adult patients with congenital microtia and rib cartilage calcification.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Microtia Auricular reconstruction Cartilage calcification Reduce of rib cartilage harvest 


Authors’ contribution

Wenshan Xing, Yue Wang, Jin Qian, Bingqing Wang and Qingguo Zhang participated in the clinical application of the technique. Wenshan Xing participated in the follow-up of the patients and analysis of data for the work. All authors participated in the conception and design of the study. Wenshan Xing drafted the article. Yue Wang, Jin Qian, Bingqing Wang, Xu Zhou, Tun Liu, Yongbiao Zhang and Qingguo Zhang revised it critically for important intellectual content. All the authors approved the version to be submitted.


The preparation of this manuscript was sponsored by the National Natural Science Foundation of China (No. 81571924, 31671312).

Compliance with Ethical Standards

Conflict of interest

The authors report no financial or personal relationships with other individuals or organizations that could inappropriately influence the work.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  • Wenshan Xing
    • 1
  • Yue Wang
    • 1
  • Jin Qian
    • 1
  • Bingqing Wang
    • 1
  • Xu Zhou
    • 1
  • Tun Liu
    • 1
  • YongBiao Zhang
    • 2
  • Qingguo Zhang
    • 1
    Email author
  1. 1.Auricular Plastic and Reconstructive Surgery Center, Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  2. 2.Beijing Advanced Innovation Center for Big Data-Based Precision MedicineBeihang UniversityBeijingChina

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