title: Accurate Measurements of the Skin Surface Area of the Healthy Auricle and Skin Deficiency in Microtia Patients.
abstract: BACKGROUND
  The limited cranial skin covering auricular implants is an important yet underrated factor in auricular reconstruction for both reconstruction surgery and tissue engineering strategies. We report exact measurements on skin deficiency in microtia patients and propose an accessible preoperative method for these measurements.
  
  
  METHODS
  Plaster ear models (n = 11; male:female = 2:1) of lobular-type microtia patients admitted to the University Medical Center Utrecht in The Netherlands were scanned using a micro-computed tomographic scanner or a cone-beam computed tomographic scanner. The resulting images were converted into mesh models from which the surface area could be calculated.
  
  
  RESULTS
  The mean total skin area of an adult-size healthy ear was 47.3 cm2, with 49.0 cm2in men and 44.3 cm2in women. Microtia ears averaged 14.5 cm2, with 15.6 cm2in men and 12.6 cm2in women. The amount of skin deficiency was 25.4 cm2, with 26.7 cm2in men and 23.1 cm2in women.
  
  
  CONCLUSIONS
  This study proposes a novel method to provide quantitative data on the skin surface area of the healthy adult auricle and the amount of skin deficiency in microtia patients. We demonstrate that the microtia ear has less than 50% of skin available compared with healthy ears. Limited skin availability in microtia patients can lead to healing problems after auricular reconstruction and poses a significant challenge in the development of tissue-engineered cartilage implants. The results of this study could be used to evaluate outcomes and investigate new techniques with regard to tissue-engineered auricular constructs.
authors.affiliation: Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: Iris A
authors.initials: IA
authors.lastname: Otto
authors.affiliation: Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: Rob F M
authors.initials: RF
authors.lastname: van Doremalen
authors.affiliation: Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: Ferry P W
authors.initials: FP
authors.lastname: Melchels
authors.affiliation: Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: Michail N
authors.initials: MN
authors.lastname: Kolodzynski
authors.affiliation: Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: Behdad
authors.initials: B
authors.lastname: Pouran
authors.affiliation: Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Malda
authors.affiliation: Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: Moshe
authors.initials: M
authors.lastname: Kon
authors.affiliation: Departments of Plastic, Reconstructive and Hand Surgery and Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands; Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands; and Department of Plastic Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: Corstiaan C
authors.initials: CC
authors.lastname: Breugem