y philosophical and scientific approach in ear construction is to do
as much as safely possible at each operation without taking undue risks
with the circulation; then I allow sufficient time for the tissues to heal
satisfactorily before proceeding. Therefore, it is rare that I will perform
more than one surgical stage at a time. Unlike wood carving or clay sculpting,
surgically sculpting tissues depends on good circulation. However, I occasionally
combine procedures when conditions are ideal and I feel that it is safe
to do so without seriously jeopardizing the tissues. The most commonly
combined procedures are the second and third operations, i.e., transposition
of the earlobe and lifting the ear with a skin graft (see Fig. 23)
Figure 23. Combining procedures.
(23a) Stage one
ear construction in microtia patient with short lobule vestige. (23b)
Ear separated from head and
earlobe raised as tissue flap. (23c) Simultaneous "ear lift" and
lobule transposition completed. This was safe because the earlobe is
small, and therefore the entire ear is not surrounded by incisions;
i.e., there is considerable uncut skin to carry circulation across
to the ear.
From Brent, B.: Auricular repair with autogenous
rib cartilage grafts: Two decades of experience with 600 cases. Plastic & Reconstructive
Surgery, 90:355, 1992, with permission.