To obtain the best rib configuration for carving the ear framework, I harvest the cartilage from the side opposite the ear being constructed (see Fig. 14) . The first free-floating cartilage tapers favorably to form the helix; a fused region of ribs six and seven provides an ample cartilage block to form the main body of the framework.Figure 14. Site of rib cartilage harvest for ear framework fabrication.
|To take advantage of natural configuration, the cartilage is obtained from side opposite to ear being constructed.|
To conserve anesthetic time, my assistant closes the chest wound while I fabricate the framework. Using this approach, the entire operation (rib harvest, framework fabrication and its insertion beneath the auricular skin) routinely takes less than three hours. I firmly believe that quick surgery with minimal exposure of open wounds greatly decreases complications. As proof of this, my first 30 cases, performed 25 years ago, took six to eight hours and experienced a 30 percent complication rate; the more than 1,700 ears I have constructed since then require less than three hours and experience a less than one percent complication rate. Admittedly, gain in experience and better technique has been a major factor as well, but the decreased open wound time surely has been an ally.
When grafting cartilage, I use intraoperative antibiotics as a prophylactic measure, and continue their use for one week after the procedure. In subsequent stages of ear repair, I do not use antibiotics, except when elevating and grafting the ear of an adolescent patient with intractable acne.
Blood loss is minimal during this surgery, and has never necessitated my giving a transfusion.