title: Modular Component Assembly Approach to Microtia Reconstruction.
abstract: BACKGROUND
  Current methods of microtia reconstruction include carving an auricular framework from the costal synchondrosis. This requires considerable skill and may create a substantial defect at the donor site.
  
  
  OBJECTIVE
  To present a modular component assembly (MCA) approach that minimizes the procedural difficulty with microtia repair and reduces the amount of cartilage to a single rib.
  
  
  METHODS
  Ex vivo study and survey. A single porcine rib was sectioned into multiple slices using a cartilage guillotine, cut into components outlined by 3-dimensional printed templates, and assembled into an auricular scaffold. Electromechanical reshaping was used to bend cartilage slices for creation of the helical rim. Chondrocyte viability was confirmed using confocal imaging. Ten surgeons reviewed the scaffold constructed with the MCA approach to evaluate aesthetics, stability, and clinical feasibility. The study was conducted from June 5 to December 18, 2014.
  
  
  METHODS
  The primary outcome was creation of a modular component assembly method that decreases the total amount of rib needed for scaffold construction, as well as overall scaffold acceptability. The surgeons provided their assessments through a Likert-scale survey, with responses ranging from 1 (disagree with the statement) to 5 (agree with the statement). Thus, a higher score represents that the surgeon agrees that the scaffold is structurally and aesthetically acceptable and feasible.
  
  
  RESULTS
  An auricular framework with projection and curvature was fashioned from 1 rib. The 10 surgeons who participated in the survey indicated that the MCA scaffold would meet minimal aesthetic and anatomic acceptability. When embedded under a covering, the region of the helix and antihelix of the scaffold scored significantly higher on the assessment survey than that of an embedded alloplast implant (mean [SD], 4.6 [0.97] vs 3.5 [1.27]; P = .007). Otherwise, no significant difference was found between the embedded MCA and alloplast implants (4.42 [0.48] vs 3.87 [0.41]; P = .13). Cartilage prepared with electromechanical reshaping was viable.
  
  
  CONCLUSIONS
  This study demonstrates that 1 rib can be used to create an aesthetic and durable framework for microtia repair. Precise assembly and the ability to obtain thin, uniform slices of cartilage were essential. This cartilage-sparing MCA approach may be an alternative to classic techniques.
  
  
  METHODS
  NA.
authors.affiliation: Medical student, School of Medicine, University of California-Irvine, Irvine2Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Gandy
authors.affiliation: Medical student, School of Medicine, University of California-Irvine, Irvine2Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine.
authors.forename: Bryan
authors.initials: B
authors.lastname: Lemieux
authors.affiliation: Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine3Department of Otolaryngology, Head and Neck Surgery, University of California-Irvine, Orange.
authors.forename: Allen
authors.initials: A
authors.lastname: Foulad
authors.affiliation: Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine3Department of Otolaryngology, Head and Neck Surgery, University of California-Irvine, Orange4Department of Otolaryngology, Head and Neck Surgery, University of California-
authors.forename: Brian J F
authors.initials: BJ
authors.lastname: Wong
mesh_terms: D000818:Animals; D065817:Congenital Microtia / Q000601:surgery*; D066186:Costal Cartilage / Q000637:transplantation*; D005240:Feasibility Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D013552:Swine; D054457:Tissue Scaffolds