목적: We investigate the outcomes and pitfalls in the surgery of total auricular reconstruction using autologous rib cartilage. 방법:We reconstructed auricle with modified Nagatas technique in 13 patients. Surgery was performed as a two stage for reconstruction (1st stage of auricular framework insertion in the skin pocket and 2nd stage of auricle elevation for formation of auriculocephalic sulcus). Only 1st stage operation was performed in 2 cases and they are waiting for 2nd stage operation. One patient underwent single stage operation using temporoparietal fascia flap due to the low-hair line. Surgical outcome was investigated by the shape of auricle (poor, moderate, good), presence of auriculocephlaic sulcus (total stricture, partial stricture, no stricture), and complications. 결과:The shape of auricle was poor in 2 cases, moderate in 5 cases, and good in 6 cases. Auriculocephalic sulcus was found to have partial stricture in all 10 cases after 2nd stage operation. Most common postop complication was twisting lobule which was found in 4 cases. Irreversible skin necrosis was found in 2 cases and corrected with local skin flap. Partial skin flap necrosis was found in 3 cases, but they are spontaneously healed after local dressing. Cartilage exposure was found only in 1 case and treated with local skin flap. 결론:Total auricular reconstruction using autologous rib cartilage is very complex and time-spending procedure. Understanding surrounding anatomical structure, careful skin flap design as well as aesthetic carving skill are essential in successful auricular reconstruction.