Postoperative Care

Ipack the new ear's convolutions with Vaseline gauze and apply a bulky, noncompressive dressing. Since the vacuum system provides both skin adherence and hemostasis, pressure is unnecessary and contraindicated. The first day, the tubes are changed by the nurses every few hours, then every four to six hours thereafter or when a tube is one-third full. Although the patient leaves the hospital the morning after surgery, the drains remain in place for another four or five days until the test tubes contain only drops of drainage.

Following surgery, patients are attended on the hospital ward. The major problems during the first day are chest discomfort (from the rib surgery) and nausea (from the anesthesia). Both of these are controlled with medications. Most patients do not experience significant ear discomfort.

The morning after surgery, the IV line is removed, and the nausea is usually gone. Most patients run a fever this day, because they are not taking deep enough breaths (due to discomfort of the chest incision) and they are trapping lung secretions. It is important that the patient take deep breaths, which is aided by use of a tri-flow respirometer and blowing up balloons.

The morning after surgery, discomfort is controlled with oral medications and the patient is discharged. Sutures are removed from the ear after one week, and bandages are discontinued after about twelve days. At two weeks, I permit the patient to resume school, but restrict running and sports for another three to four weeks while the chest wound heals.

A little recovering microtia patient, holding her doll which also has bandages around its head!

Wound Care

During the first month after surgery, I advise patients to take a few precautions to allow the ear to heal without problems: Once the dressing is removed, the hair may be washed with lukewarm water. It is probably wise to use a little caution not to soak the new ear at this first washing, although a little water on it will do no harm. After several weeks one can shampoo and shower in the usual fashion, wetting the new ear as though no surgery had ever been performed. However, one should avoid using hot hair dryers on the new ear for about six to eight weeks, as the skin will at first be a little tender from the surgery and needs to be allowed to heal without the stress of heat. Because surgery makes the skin swell, the constructed ear may look somewhat swollen for several weeks or more. As the skin swelling subsides, the carved rib details will gradually appear.

Sleeping on the New Ear

Patients should avoid sleeping on their new ears, particularly during the first month. This can be facilitated by propping several pillows behind the patients' backs as they sleep on their sides. I prefer that patients get out of the habit of sleeping on their surgically-constructed ear because I feel that continually doing this may possibly flatten out some of the details of the ear's outer rim. However, I must admit that I have rarely seen this problem during my 25 years of practice [23]. Furthermore, and obviously, we all turn in our sleep, and it is impossible to keep from rolling over on the ear now and then; a few patients insist on sleeping on the ear; furthermore, some patients have had two ears surgically repaired and it is therefore difficult staying off their ears altogether. For these reasons, I encourage patients to use very soft pillows (preferably feather down) so that if they roll over during sleep they won't be subjecting the ear to firm pressure. By a month after the surgery, sleeping on the ear is no longer an issue.

Activities and Sports

I restrict sports for four to five weeks in children; and for six weeks in teenagers and adults. This is not done so much for the ear as for the chest, which is a much more significant wound. Just like in abdominal or hernia surgery, muscles have been split, and although they have been stitched back together, they must be allowed sufficient time to heal before the patient is allowed to run, jump, bicycle, swim, strenuously lift, etc. Once back to sports, the patient is allowed to play baseball and other sports with no special protection, and can carry on like anyone else in most activities. These ears are made out of the patient's own living tissues, and tolerate bumping and trauma about like a normal ear. However, unusually traumatic activities such as boxing are discouraged. If the patient is to wear a helmet (such as for motorcycling or football), it might need to be modified to accommodate the new ear so that nothing is roughly scraping it inside the helmet. If need be, one could cut out an area and line it with soft foam rubber.