Cartilage Framework Fixation with 2-Octyl Cyanoacrylate in a Prelaminated Radial Forearm Free Flap Total Auricular Reconstruction

Autologous total auricular reconstruction requires an intricately sculpted, curved, and stacked cartilaginous framework implanted under healthy vascularized tissue. The ideal fixation technique would be readily available, easy to deploy, and free of complications. Commonly used sutures can fracture fragile pieces, inadequately maintain shape, or migrate. Steel wire can erode through soft tissues, extrude, fracture, or become infected. We successfully used 2-octyl cyanoacrylate alone to fixate an autologous costal cartilage framework designed for a total auricular reconstruction in an adult trauma patient. We had no sutures or wires in the final construct. The key aspects of our technique included the following: use of small aliquots, application only at cartilage-to-cartilage interfaces, use of temporary shaping (needles and lasso sutures), and avoidance of excess spillage of adhesive on any portion that would directly contact soft tissue. The framework was implanted into a prelaminated radial forearm free flap, which was then transferred to the head and neck region at a second stage. At two-year follow-up, the framework held satisfactory shape without any complications such as resorption, exposure, or infection.