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EAR RECONSTRUCTION

Neil Bulstrode is an international authority regarding ear reconstruction and was a co-founder of the International Society for Auricular Reconstruction and its first Secretary General.

BEFORE AND AFTER PHOTOS

MEDIA REPORTS ABOUT EAR RECONSTRUCTION

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SUPPORT GROUPS

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GENERAL DISCUSSION

Topics to be considered and discussed

  • Nature of congenital defect

  • Options for reconstruction

    • No reconstruction needs to be performed

    • Bone anchored prosthesis

    • Autologous carved rib framework

  • Timing of procedure (9 years old onwards)

  • Risks

SURGICAL PROCEDURE

Details of the surgical procedure and follow up

First Stage​

  • General anaesthetic

  • Per-operative antibiotics

  • Around 4 hours of operating

  • Harvest rib cartilage from ipsilateral chest

  • Carve framework

  • Costal nerve local anaesthetic blocks

  • Block of cartilage places back under the skin in chest wound for 2nd stage

  • Create pocket and reposition remnant

  • Place framework in pocket and close

  • Suction drains allow skin to conform to the contours of the framework

  • Dressing

  • Suction drain protocol up to 6 days

  • Pain relief and antibiotics

  • Dressing clinic attendance when required

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Second Stage

  • General anaesthetic

  • Per-operative antibiotics

  • Around 2 hours of operating

  • Re-harvest cartilage block from ipsilateral chest

  • Harvest split thickness skin graft (SSG) from scalp

  • Release ear

  • Fix shaped cartilage block

  • Raise post-auricular galial flap and cover cartilage

  • Advance post auricular skin

  • Apply SSG

  • Apply tie over

  • Mepitil and chloramphenicol to scalp donor site

  • Pain relief and antibiotics

  • Remove drain next day and Home

  • Dressing and tie over removed 1/52 further dressing at night

  • Dressing clinic appointments when required

  • OPA 3/12 to discuss outcome

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Third Stage

  • This would depend on the perceived needs and may a involve either the reconstructed ear or the other side in-order to improve the overall appearance

POTENTIAL RISK

Whilst the chance of risk is very low, it must be discussed and understood

First Stage

  • Risks of General Anaesthetic (detailed explanation by Anaesthetist)

  • Donor

  • Scar

    • Scar, hypertrophic, keloid and/or stretched

    • Pain, improves with time

    • Pneumothorax (normally identified during operation and closed)

    • Pneumothorax leading to chest drain (rare)

    • Bruising

    • Bleeding

    • Infection

    • Contour defect

  • Recipient​

    • Scar, hypertrophic, keloid, and/or stretched

    • Pain, improves with time

    • Delayed wound healing requiring return trips to dressing clinic

    • Cartilage exposure (rare) would lead to further procedure to cover cartilage

    • Bruising

    • Bleeding

    • Haematoma would lead to further procedure to remove collection of blood

    • Infection would require antibiotics and possible further procedure (this would be serious but luckily is rare)

    • Infection could lead to resorption of cartilage framework and need for further procedure

    • Cartilage graft exposure which can lead to a further surgical procedure if it does not heal secondarily

    • Wire extrusion which always needs to be removed to reduce the chance of infection and cartilage resorption

    • Facial nerve palsy (rare)

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Second Stage

  • Risks of General Anaesthetic (detailed explanation by Anaesthetist)

  • Donor (Chest)​

    • Scar, hypertrophic, keloid, and/or stretched

    • Pain, improves with time

    • Pneumothorax (rare)

    • Bruising

    • Bleeding

    • Infection

  • Donor (Scalp)

    • Alopecia (skin taken superficial to hair bulbs so very rare)

    • Hair growth covers healed area

    • Bleeding

    • Infection

  • Recipient​

    • Scar, hypertrophic, keloid, and/or stretched

    • Pain, improves with time

    • Delayed wound healing requiring return trips to dressing clinic

    • Graft loss may lead to further procedure

    • Cartilage exposure (rare) would lead to further procedure to cover cartilage

    • Bruising

    • Bleeding

    • Haematoma would lead to further procedure to remove collection of blood

    • Infection would require antibiotics and possible further procedure (This would be serious but luckily is rare)

    • Infection could lead to resorption of cartilage framework and need for further procedure

    • Asymmetry

    • Facial nerve palsy (rare)

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Third Stage

  • Risks are similar to those listed above

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