Combining Surgical Stages

My 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.

Figure 23. Combining procedures. Figure 23. Combining procedures. Figure 23. Combining procedures.
23a
23b 23c

(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.