Artistic Reconstructive Plastic Surgery for Congenital Microtia & Anotia
Congenital microtia is a developmental anomaly where the external ear (pinna) fails to develop properly, ranging from a small, malformed ear with missing landmarks (Grade II/III) to complete absence of the ear (anotia). Total auricular reconstruction is widely regarded as one of the most artistically demanding and technically complex procedures in plastic surgery, requiring the surgeon to hand-sculpt a three-dimensional living ear framework from the patient's own rib cartilage.
The Two-Stage Nagata Autologous Reconstruction Protocol
Dr. Vishal Purohit employs the internationally acclaimed Nagata technique, performed in two staged procedures:
- Stage 1 — Cartilage Harvesting & 3D Framework Carving: Harvesting the 6th, 7th, 8th, and 9th costal cartilage from the chest wall. The cartilage is meticulously hand-carved with scalpels into a base plate, helix, antihelix, tragus, and antitragus, spliced with fine wire, and inserted into an expansive subcutaneous skin pocket on the head.
- Stage 2 — Ear Elevation & Projection (6 Months Later): Elevating the healed framework away from the mastoid bone to match the projection of the opposite normal ear, lining the retroauricular sulcus with a temporoparietal fascia (TPF) flap and skin graft.
Psychosocial and Functional Transformation
Typically performed around age 9 to 10 when chest rib cartilage is sufficiently voluminous and the child can participate in care, autologous ear reconstruction provides a permanent, growing, living ear that enables wearing glasses, face masks, and eliminates social stigma.