Framework Fabrication

Using scalpels and sterilized wood-carving chisels, I carve the basic ear silhouette from the main cartilage block. It is necessary to thin little, if any, of the basic form for a small child's framework, but cartilage thinning is essential for adult frameworks. Even when thinning is necessary, I preserve as much of the covering perichondrial tissue as possible on the outer aspect of the framework to facilitate its adherence to and subsequent nourishment from surrounding tissues.

Figure 15. Fabricating an ear framework from rib cartilage.

Figure 15. Fabricating an ear framework from rib cartilage.
(15A) Donor site: chest on side opposite to ear being repaired. The helical rim is obtained from a "floating" rib cartilage, the main pattern from a fused block of two cartilages. (15B) Sculpting the main block with chisel. (15C) Thinning the "floating" rib cartilage to produce the helical rim. (15D) Affixing the rim to the main framework with nylon sutures. (15E) Completed framework.

From Brent, B.: Total auricular construction with sculpted costal cartilage. In B. Brent (Ed.), The Artistry of Reconstructive Surgery, St. Louis, 1987, The C.V. Mosby Co., pp. 113-127.

When creating the helical rim, the floating rib cartilage is thinned on its outer, convex surface to cause deliberate warping [48] in a favorable direction (see Fig. 15). This allows me to produce the acute flexion necessary to create a helix, which I then fasten to the framework body with clear nylon sutures.

Finally, the living sculpture is completed by carving the rest of its details with chisels (see Fig. 16). Through years of observing the healing process, I continue to evolve and modify the framework sculpture to achieve optimal definition, stability, and projection.

Figure 16. Actual completed ear framework, sculpted from patient's rib cartilage as illustrated in Figure 15.


Figure 16. Actual completed ear framework, sculpted from patient's rib cartilage as illustrated in Figure 15.
From Brent, B.: Total auricular construction with sculpted costal cartilage. In B. Brent (Ed.), The Artistry of Reconstructive Surgery, St. Louis, 1987, The C.V. Mosby Co., pp. 113-127.