Current management of microtia: a national survey.
BACKGROUND
Microtia reconstruction remains one of the most challenging procedures encountered by the reconstructive surgeon. A national report on the current management of microtia has never been presented before. The purpose of this project was to survey members of the American Society of Plastic Surgeons (ASPS) to identify their preferences and practices and report their opinions regarding issues related to microtia reconstruction.


METHODS
An anonymous web-based survey consisting of 19 questions was distributed to the members of the ASPS. Questions focused on the management of microtia. The study design was descriptive, using categorical data analysis.


RESULTS
Thirty-eight percent of all respondents perform microtia reconstruction; 91 % learned the autogenous cartilage-based reconstruction technique, while only 16 % were exposed to alloplastic reconstruction. Seventy percent of all respondents learned autogenous cartilage-based ear reconstruction exclusively. Fifty percent of respondents who perform microtia reconstruction reported a steep learning curve. In the pediatric patient population, 49 % of microtia surgeons prefer performing the surgery when the patient is between 7 and 10 years of age, while 40 % of microtia surgeons prefer the patient to be 4-6 years of age. Fifty-nine percent of all respondents believe that in 15 years tissue engineering will represent the gold standard of microtia reconstruction.


CONCLUSIONS
Staged microtia repair using autogenous cartilage remains the heavily favored method of microtia reconstruction among plastic surgeons. Moreover, there is a deficiency in training the newer surgical techniques, such as alloplastic and osseointegrated options. This study also highlights the continuing need to elucidate the optimal timing for microtia repair in the pediatric patient to mitigate the potential psychosocial morbidity well described in the literature.


METHODS
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 www.springer.com/00266 .
University of Southern California (USC) Medical Center, Keck School of Medicine, 401 S. Detroit St. #209, Los Angeles, CA 90036, USA. daniel.im@usc.edu
Daniel D
DD
Im
Boris
B
Paskhover
David A
DA
Staffenberg
Reza
R
Jarrahy
D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000601:surgery*; D065817:Congenital Microtia; D003430:Cross-Sectional Studies; D004423:Ear / Q000002:abnormalities / Q000601:surgery; D004425:Ear Cartilage / Q000002:abnormalities / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014182:Transplantation, Autologous; D014481:United States