Strategies for Surgical Refinement of the Antihelical Complex Using Autologous Costal Cartilage in Auricular Reconstruction for Microtia

<b>Background:</b> In microtia reconstruction, surgeons must identify the various qualities of costal cartilage that can be used to create the nuances of the antihelical complex of the new auricular construct. <b>Objective:</b> To compare the techniques for antihelical complex fabrication among microtia patients undergoing two-stage ear reconstruction with autogenous cartilage based on different characteristics of autologous cartilage, as measured by photograph analysis and patient survey. <b>Methods:</b> This is a retrospective chart of patients undergoing microtia reconstruction using autogenous rib cartilage from 2017 to 2023. Reconstructed auricles were evaluated by three blinded expert graders using a satisfaction rating of 1-10. Patient surveys were collected (ear size, location, symmetry, and duplication of the reconstructed ear and possible complications). <b>Results:</b> Overall, 529 patients were included with a male preponderance (<i>n</i> = 357/529, 68%) with a mean age of 13.91 ± 6.34 (range: 6-39 years). Mean follow-up was 18.28 ± 7.53 months (range: 10-36 months). Complications (<i>n</i> = 36) were reported, which included flap congestion (<i>n</i> = 12), skin necrosis, and cartilage exposure (<i>n</i> = 9). Photograph review showed a mean score of 9.01 ± 0.42 (range: 8.51-9.53). Patient satisfaction scores were 9.47 ± 0.31 (range: 8.90-9.81). <b>Conclusion:</b> Surgeons can properly create the antihelical complex in autologous costal cartilage framework.