Table 1 Summary of total autologous auricular reconstructive techniques

Tanzer [20–22]

Four stages:

1. Rotation of the lobule into a transverse position

2. Fabrication and placement of a costal cartilage framework

3. Elevation of the ear from the side of the head

4. Construction of a tragus and conchal cavity

– First stepwise total auricular reconstruction

– Good results

– Multiple operations

– Transposing lobule first poses risk of vascular compromise of skin flap [64]

Brent [23–28]

Four stages:

1. Rib cartilage framework fabrication and placement

2. Lobule transposition

3. Elevation of framework and creation of a retroauricular sulcus

4. Conchal excavation and tragus construction

– Good contour

– Postoperative drain limits complications of bolster dressings [64]

– Multiple operations

– Lack definition of conchal bowl [64]

– Composite skin/cartilage tragal grafts can contract [37]

Nagata [31–36]

Two stages:

1. Fabrication of costal cartilage framework including the tragus, conchal excavation and rotation of the lobule

2. Elevation of framework, placement of cartilage graft in auriculocephalic sulcus, covered with temporoparietal fascial flap and skin graft

– Less operations

– High-definition framework to create a good tragus [64]

– More cartilage needed

– Detailed framework so long learning curve

– Minimum age 10 years

– Partial necrosis of posterior flap [37]

– Wire sutures increase extrusion [37]