Evolution and Hotspots in Autologous Ear Reconstruction: A Bibliometric Analysis of the 100 Most-cited Studies.

Abstract

Background: Autologous auricular reconstruction has evolved from cartilage-carving techniques that established modern microtia repair to an expanding regenerative and biofabrication literature. However, the field has not been mapped bibliometrically using an autologous-only lens that separates the clinical literature from emerging tissue-engineering hotspots.

Methods: A Scopus search in January 2026 identified publications on autologous auricular reconstruction. Records were sorted by citation count, screened for eligibility, and the 100 most-cited studies were included. Data extracted included citations, citations per year, year, journal, country, and evidence category. Studies were classified into 4 domains: surgical technique, tissue engineering/basic science, complications/management, and outcomes/quality of life. VOSviewer was used for coauthorship and keyword co-occurrence mapping. Temporal shifts were assessed by comparing the older versus newer halves.

Results: The 100 most-cited studies (1971-2023) accrued a mean of 82.97 citations (range, 27-510) with a median of 3.46 citations per year. Most studies were clinical (71%), followed by preclinical (19%) and evidence synthesis (10%). Surgical technique predominated overall (53%), but decreased from 66% in the older half to 40% in the newer half, whereas tissue engineering increased from 16% to 28%. The most-cited article was the description by Nagata of a 2-stage, 3-dimensional costal cartilage framework (1993, Plastic and Reconstructive Surgery). Keyword clustering revealed a temporally newer regenerative cluster centered on chondrocytes, tissue engineering, and biomechanics.

Conclusions: The citation canon of autologous auricular reconstruction is built on the late 20th-century technique classics, whereas contemporary influence is increasingly driven by regenerative medicine and biofabrication. Future high-impact work will likely be defined by durable, shape-stable engineered constructs validated in clinically relevant models.