title: Reconstruction of congenital tragal malformations accompanied by dystopic cartilage growth (accessory tragus).
abstract: BACKGROUND
  Patients with solitary-type congenital tragal malformations accompanied by dystopic cartilage growth (accessory tragus) show not only a disfigured or absent tragus but also unnecessary tragal or pretragal lumps. Furthermore, an absent tragus causes a wholly exposed external auditory canal.
  
  
  METHODS
  Sixty-five ears (54 patients) showing congenital tragal malformations accompanied by dystopic cartilage growth were reconstructed from March of 1991 to February of 2014. Reconstructions were reviewed using medical records and photographs, surgical methods were analyzed, and postoperative outcomes were evaluated.
  
  
  RESULTS
  Six kinds of tragal framework fabrication methods were used in the reconstructions: free cartilage grafting (n = 7); cartilage transposition and anchoring (n = 7); cartilage folding and anchoring (n = 46); vascularized chondrocutaneous island flap (n = 4); and costal cartilage grafting (n = 1). Immediate postoperatively, four cases showed congestion of the covered skin. Forty-three patients (78 percent) were followed up for an average period of 15 months. The following were observed: larger tragus (n = 3); flat tragus without peak (n = 2); posterior protrusion of the tragal wall (n = 2); and hypertrophic scar (n = 1). All cases with a wholly exposed external auditory canal were corrected. The average score of the aesthetic outcomes, rated on a four-point Likert scale (1 = poor, 2 = fair, 3 = good, 4 = excellent), was 3.8 points.
  
  
  CONCLUSIONS
  Cartilage and covered skin from the dystopic cartilage growth provided the best-available tissues for new tragal reconstructions. Different surgical techniques were used in accordance with the severity of the tragal malformation encountered. Most techniques provided aesthetically pleasing outcomes.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Seoul, South Korea From The Seoul Center for Developmental Ear Anomalies and the Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital.
authors.forename: Chul
authors.initials: C
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D064592:Autografts; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000601:surgery*; D066186:Costal Cartilage / Q000637:transplantation*; D054644:Ear Auricle / Q000002:abnormalities* / Q000601:surgery*; D004425:Ear Cartilage / Q000002:abnormalities / Q000601:surgery; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D055815:Young Adult