1st Stage | 2nd Stage | 3rd Stage | 4th Stage

1st Stage:

Rib Harvest
Creation of Skin Pocket
Placement of New Ear Framework

The 1st stage consists of two separate procedures: 1) Harvesting the rib cartilage 2) Inserting the carved, sculpted cartilage into a skin pocket under the microtic ear. The length of surgery is approximately 2 1/2 to 3 1/2 hours the children are discharged the next 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 following shape ensues. A small piece of extra rib is inserted via a small incision behind the ear and is saved for the 3rd stage.

During the carving and sculpting of the ear, our pediatric anesthesiologists give our patients pain medication through epidurals. This has dramatically improved the post-operative discomfort. With the epidurals, pain control is maximized. Very often, the children feel no discomfort immediately after the surgery.

INSERTION OF NEW EAR FRAMEWORK INTO SKIN POCKET

Now it is time to insert the new ear framework into a skin pocket under the microtic ear. The 1st of four stages is now completed.

Post-operative Instructions:

The patients are discharged the day after surgery. I send my patients home on pain medication and antibiotics. An ear dressing is applied during surgery and is left intact for about three days. At that time, the wound is checked and the ear re-bandaged. 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 framework. The sutures are removed on the seventh post-operative day. 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 approximately 3 months later.