{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T23:06:11Z","timestamp":1777676771595,"version":"3.51.4"},"reference-count":22,"publisher":"Georg Thieme Verlag KG","issue":"02","license":[{"start":{"date-parts":[[2019,8,26]],"date-time":"2019-08-26T00:00:00Z","timestamp":1566777600000},"content-version":"vor","delay-in-days":1578,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Indian J Plast Surg"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Introduction: An ideal ear, with representation of all anatomic landmarks, is the aim of any reconstructive surgeon embarking on reconstructing the ear in a microtia patient. The literature is abundant with the description of techniques, but these have been reported mainly in Caucasian and Oriental population. There have been very few publications on results in the population belonging to the Indian subcontinent. In spite of strictly adhering to the recommended techniques of reconstruction, the results obtained in these patients have often been marred by problems that are not reported with the Oriental or Caucasian populations. This may necessitate a relook into the management strategy of these cases. Hindering the assessment of the results, their reporting and auditing the improvement obtained by such change in the management strategy, is the lack of a standardized method for assessment of the outcome. Hence, an attempt was made in a series of patients who underwent microtia reconstruction to assess the outcome using a new tool based on the attained definition of anatomical components of the reconstructed pinna. Further effort was made to document the modifications in the technical execution of the reconstruction during the period of the study. Materials and Methods: A retrospective review of 44 patients and a prospective analysis of 11 patients, who underwent ear reconstruction for microtia from December 2003 to September 2014 at a tertiary care teaching hospital, was undertaken. Taking a cue from Nagata\u2019s description of an \u2019ideal reconstructed ear\u2019 which should show all the anatomical components, we developed an objective grading system to assess our results. The technique had undergone several changes during these years combining the principles of three universally accepted methods, that is, those described by Nagata, Brent, and Firmin. These changes, as well as the reasons behind them, were documented. Results: On objectively measuring and analysing the replication of normal morphologic characteristics of the reconstructed ears, we documented progressive improvement of our results. Good or excellent results could be achieved in 70% of cases in the second group compared to a poor outcome in more than 2\/3rd of the cases carried out during the initial period. Based on these results and the changes adopted in our practice we propose suggestions for management of microtia cases in the Indian population. Conclusions: An objective, weighted grading system has further enabled us to critically evaluate the outcomes and to further improve upon the existing results. Our amalgamation of the salient features of the established techniques as well as changes made based on our experience has enabled us to get good results more consistently in our attempts at microtia reconstruction. We believe that the adoption of such amalgamated methods will be more suitable in Indian patients.<\/jats:p>","DOI":"10.4103\/0970-0358.163050","type":"journal-article","created":{"date-parts":[[2015,8,18]],"date-time":"2015-08-18T06:23:54Z","timestamp":1439879034000},"page":"144-152","source":"Crossref","is-referenced-by-count":12,"title":["Objective analysis of microtia reconstruction in Indian patients and modifications in management protocol"],"prefix":"10.1055","volume":"48","author":[{"given":"Mohit","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raghuveer Reddy","family":"Dudipala","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jimmy","family":"Mathew","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhijeet","family":"Wakure","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krishnakumar","family":"Thankappan","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak","family":"Balasubramaniam","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Subramania","family":"Iyer","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery and Head and Neck Surgery and Oncology and Cranio-Maxillofacial Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2019,8,26]]},"reference":[{"key":"key-10.4103\/0970-0358.163050-1","first-page":"337","volume-title":"Artistic anatomy, dimensions, and proportions of the external ear","author":"Tolleth","year":"1978","journal-title":"Clin Plast Surg"},{"key":"key-10.4103\/0970-0358.163050-2","first-page":"1","volume-title":"Total reconstruction of the external ear","author":"Tanzer","year":"1959","journal-title":"Plast Reconstr Surg Transplant Bull"},{"key":"key-10.4103\/0970-0358.163050-3","first-page":"1","volume-title":"The correction of mi-rotia with autogenous cartilage grafts: I.The classic deformity?","author":"Brent","year":"1980","journal-title":"Plast Reconstr Surg"},{"key":"key-10.4103\/0970-0358.163050-4","first-page":"13","volume-title":"The correction of microtia with autogenous cartilage grafts: II.Atypical and complex deformities","author":"Brent","year":"1980","journal-title":"Plast Reconstr Surg"},{"key":"key-10.4103\/0970-0358.163050-5","first-page":"931","volume-title":"A new reconstruction for microtia of the lobule","author":"Nagata","year":"1989","journal-title":"Jpn Plast Reconstr Surg"},{"key":"key-10.4103\/0970-0358.163050-6","first-page":"187","volume-title":"A new method of total reconstruction of the auricle for microtia","author":"Nagata","year":"1993","journal-title":"Plast Reconstr Surg"},{"key":"key-10.4103\/0970-0358.163050-7","first-page":"221","volume-title":"Modification of the stages in total reconstruction of the auricle: Part I.Grafting the three-dimensional costal cartilage framework for lobule-type microtia","author":"Nagata","year":"1994","journal-title":"Plast Reconstr Surg"},{"key":"key-10.4103\/0970-0358.163050-8","first-page":"231","volume-title":"Modification of the stages in total reconstruction of the auricle: Part II.Grafting the three-dimensional costal cartilage framework for concha-type microtia","author":"Nagata","year":"1994","journal-title":"Plast Reconstr Surg"},{"key":"key-10.4103\/0970-0358.163050-9","first-page":"243","volume-title":"Modification of the stages in total reconstruction of the auricle: Part III.Grafting the three-dimensional costal cartilage framework for small concha-type microtia","author":"Nagata","year":"1994","journal-title":"Plast Reconstr Surg"},{"key":"key-10.4103\/0970-0358.163050-10","first-page":"254","volume-title":"Modification of the stages in total reconstruction of the auricle: Part IV.Ear elevation for the constructed auricle","author":"Nagata","year":"1994","journal-title":"Plast Reconstr Surg"},{"key":"key-10.4103\/0970-0358.163050-11","first-page":"254","volume-title":"Secondary reconstruction for unfavorable microtia results utilizing temporoparietal and innominate fascia flaps","author":"Nagata","year":"1994","journal-title":"Plast Reconstr Surg"},{"key":"key-10.4103\/0970-0358.163050-12","first-page":"371","volume-title":"Total auricular reconstruction with a three-dimensional costal cartilage framework","author":"Nagata","year":"1995","journal-title":"Ann Chir Plast Esthet"},{"key":"key-10.4103\/0970-0358.163050-13","doi-asserted-by":"crossref","unstructured":"Rohrich RJ, Hoxworth RE. 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Philadelphia: Saunders Elsevier; 2009. p. 671-99.","DOI":"10.1016\/B978-1-4160-4081-1.50056-4"},{"key":"key-10.4103\/0970-0358.163050-14","first-page":"257","volume-title":"A novel algorithm for autologous ear reconstruction","author":"Firmin","year":"2011","journal-title":"Semin Plast Surg"},{"key":"key-10.4103\/0970-0358.163050-15","first-page":"381","volume-title":"Facial skin rejuvenation in the Asian patient","author":"Kim","year":"2007","journal-title":"Facial Plast Surg Clin North Am"},{"key":"key-10.4103\/0970-0358.163050-16","first-page":"79","volume-title":"Ethnic skin types: Are there differences in skin structure and function?","author":"Rawlings","year":"2006","journal-title":"Int J Cosmet Sci"},{"key":"key-10.4103\/0970-0358.163050-17","first-page":"188","volume-title":"Total auricular reconstruction with autogenous costal cartilage framework for congenital microtia (grade-III)","author":"Jain","year":"2002","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"key-10.4103\/0970-0358.163050-18","first-page":"47","volume-title":"Auricular reconstruction of congenital microtia using autogenous costal cartilage: Report of 27 cases","author":"Chauhan","year":"2012","journal-title":"J Maxillofac Oral Surg"},{"key":"key-10.4103\/0970-0358.163050-19","doi-asserted-by":"crossref","unstructured":"Firmin F. State of the art autogenous ear reconstruction in cases of microtia. In: Staudenmaier R (Ed), editor. Aesthetics and functionality in ear reconstruction. Adv Otolaryngol. Basel, Karger 2010;68:25-52.","DOI":"10.1159\/000314561"},{"key":"key-10.4103\/0970-0358.163050-20","doi-asserted-by":"crossref","unstructured":"Nagata S. Auricular reconstruction: Congenital auricular defects - Microtia. In: Guyuron B, Eriksson E, Persing J, editors. Plastic Surgery: Indications and Practice. Philadelphia: Saunders Elsevier; 2008.","DOI":"10.1016\/B978-1-4160-4081-1.50056-4"},{"key":"key-10.4103\/0970-0358.163050-21","unstructured":"Thorne CH. Ear reconstruction. In: Thorne CH, editor. Grabb & Smith\u2032s Plastic Surgery. 7 th ed. Philadelphia: Lippincott, Williams & Wilkins; 2014."},{"key":"key-10.4103\/0970-0358.163050-22","first-page":"458","volume-title":"Use of triamcinolone acetonide injection in ear reconstruction","author":"Bhandari","year":"2000","journal-title":"Ann Plast Surg"}],"container-title":["Indian Journal of Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.4103\/0970-0358.163050.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,8,29]],"date-time":"2019-08-29T10:04:21Z","timestamp":1567073061000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.4103\/0970-0358.163050"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,5]]},"references-count":22,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2019,8,26]]},"published-print":{"date-parts":[[2015,5]]}},"URL":"https:\/\/doi.org\/10.4103\/0970-0358.163050","relation":{},"ISSN":["0970-0358","1998-376X"],"issn-type":[{"value":"0970-0358","type":"print"},{"value":"1998-376X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,5]]}}}