Using the film template and preoperatively-determined measurements, I mark the ear's position and make a small incision along the ear vestige. Once I have dissected out and removed the gnarled cartilage remnant beneath the skin, I use surgical scissors to develop a thin skin "pocket," taking great care not to damage the small blood vessel network that nourishes the skin. To recruit sufficient tension-free skin coverage, the dissection is carried well beyond the marked ear outline.
Following any necessary adjustments either to the framework height or to the pocket adequacy, I insert two small silicone drains beneath and behind the framework and then into vacuum test tubes (see Fig. 17). This creates a continuous suction that not only adheres the nourishing skin flap to the carved cartilage, but also prevents possible disastrous blood clots.
Figure 17. The skin "pocket".
|The unusable cartilage remnant is removed, then a skin
pocket is created. In order to provide tension-free accommodation of
the framework, the dissection is carried out well beyond the proposed
Using silicone catheters, the skin is adhered to the framework by means of vacuum tube suction.