Forming the "Skin Pocket"

OOnce the cartilage carving is completed, meticulous technique is used to create a skin "pocket" in the proposed auricular region so as to provide a nourishing, protective covering for the new ear framework. Because of the time lapse during the rib harvest and framework fabrication, I minimize contamination risk by prepping and scrubbing the ear region just prior to beginning the skin dissection.

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".

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 auricular position.

Using silicone catheters, the skin is adhered to the framework by means of vacuum tube suction.