Reconstruction of Postburn Ear Defects: Utilizing Expanded Scar-Cartilage Composite Tissue Flaps to Cover Custom-Shaped Frameworks

Postburn auricular reconstruction presents significant challenges due to scar contracture and compromised vascularity of the surrounding tissue. This study introduces and evaluates a specialized 3-stage surgical protocol that integrates expanded scarred skin with residual cartilage and a custom-shaped autologous costal cartilage framework. A retrospective case series was conducted on 21 patients with postburn ear defects treated between January 2021 and 2024. The surgical approach involved 3 stages: (1) subcutaneous implantation of a tissue expander to release scar contractures and expand residual tissue; (2) formation of a composite flap using the expanded scarred skin and mobilized residual cartilage to envelop a custom-sculpted framework carved from selected costal cartilages; and (3) refinement of anatomic subunits. Aesthetic outcomes were assessed by independent plastic surgeons using a 4-point Likert scale, and patient-reported satisfaction and quality of life were evaluated with the EAR-Q questionnaire. The mean follow-up duration was 21.93±16.01 months. Aesthetic evaluations yielded high satisfaction, with most cases rated as "Excellent" (n=7, 33.3%) or "Good" (n=13, 61.9%). Patient-reported outcomes through the EAR-Q demonstrated high mean scores in the "Psychological" (63.00, IQR=55.50-89.00) and "Social" (64.00, IQR=6.00-85.50) domains. A strong positive correlation was observed between psychological adjustment and social functioning (τ=0.670, P<0.001). No patients reported dissatisfaction or major complications. By integrating residual cartilage into the expanded flap, this technique effectively addresses the challenges of compromised vascularity and scar contracture, resulting in improved auricular symmetry and projection, as well as significant psychosocial benefits for patients.