Our Evolved Technique for Microtia Reconstruction: An Advanced Form of the Yotsuyanagi Method

Background: Reconstruction of microtia remains a complex challenge in plastic surgery, particularly in achieving both aesthetic and functional outcomes. Since the introduction of costal cartilage grafting, various techniques have evolved, including the Nagata method. However, limitations such as rigidity of the framework, high cartilage volume requirement, and complications from temporoparietal fascia (TPF) flaps persist. Methods: The authors present our refined technique for lobule-type microtia reconstruction, now known in Japan as the Yotsuyanagi Method. This approach emphasizes a hybrid cartilage framework that combines costal cartilage with elastic remnant cartilage to improve flexibility, especially in the tragus and antitragus. Key surgical refinements include defined allocation of costal cartilage segments to auricular components, use of nylon sutures instead of stainless steel wire, and a two-step procedure allowing delayed trimming of excess skin. Auricular elevation is enhanced through the use of banked support cartilage and superficial mastoid fascia, avoiding the need for TPF flaps. Results: This technique allows for the reconstruction of a symmetric, three-dimensional auricle with improved compatibility for earphones and hearing aids. The hybrid cartilage design maintains elasticity without compromising structural integrity. Operation time is reduced, long-term complications such as wire exposure are minimized, and secondary revisions are simplified. Aesthetic results, including sufficient conchal depth and natural contour, have been consistently favorable. Conclusion: Our evolved method for microtia reconstruction offers significant advantages over traditional approaches by reducing patient morbidity, enhancing postoperative outcomes, and achieving a more natural auricular form. Ongoing refinement and long-term evaluation will further optimize results for patients undergoing auricular reconstruction.