Rib Harvest / Creation of Skin Pocket / Placement of New Ear Framework /
Applying Suction to New Ear Framework
The first surgical stage consists of several phases: 1) Harvesting the rib cartilage 2) Fabrication and sculpting of the newly formed cartilaginous framework 3) Creation of a skin pocket and insertion of the sculpted cartilage into the skin pocket. 4) Applying suction to new ear framework.
Length of Surgery: Approx. 2 1/2 to 3 hours
Length of Hospital Stay: Discharged the following morning
Harvesting the Rib Cartilage
A slightly oblique chest incision is made over the 6th, 7th and 8th ribs close to the sternum (on the opposite side of the microtic ear). On a thin child, the incision is about 1 inch to 1 1/2 inches
The 6th and 7th ribs are usually fused together and will form the base framework of the new ear. The 8th rib is used to form the rim of the ear called the “helix”.
Once the three pieces of rib are carved, sculpted and sutured together, the cartilaginous framework as noted in the picture on the right is now formed.
Placement of a Pediatric Epidural
A wonderful advancement in providing a comfortable postoperative course after surgery has been the administration of pain medication via a pediatric epidural. This is performed by anesthesiologists who have safely performed thousands of these procedures.
The epidural is placed during the carving and sculpting of the ear. Because the children are already under anesthesia, they feel absolutely no discomfort. This has dramatically improved the post-operative discomfort. With the intra-operative epidurals, pain control is maximized. Very often, the children feel no discomfort immediately after the surgery.
Creation of a Skin Pocket
An incision is made in front of the microtic vestige and a skin pocket is undermined. The upper part of the microtic vestige is usually made up of disorganized cartilage under the skin. This disorganized cartilage is removed to allow more space for the insertion of the newly created cartilaginous framework.
Insertion of New Ear Framework into Skin Pocket
A drain is placed in the skin pocket to allow for suction of the skin over the cartilaginous framework. This cartilaginous framework is now inserted under the skin pocket and the suction is applied. An ear protective cup is then placed for protection. The 1st of four stages is now completed
- The child is admitted overnight. During this overnight stay, there is one-on-one nursing care. The nurses educate the parents on drain management and give instructions to the parents concerning activities, etc…
- The child is evaluated the next morning and sent home on antibiotics and pain medication (if needed).
- The drain stays in place for about 5 to 7 days to provide negative suction so that the skin can co-apt to the newly inserted cartilaginous framework.
- The sutures are removed after 7-10 days.
- Contact sports are restricted for about 4 to 6 weeks.
- The hair may be washed a few weeks after surgery.
- The next stage may proceed a few months later.