Outer ears reconstructed using rib cartilage
UN/DICYT This experience was published in the 1990s in the Colombian Journal of Plastic Surgery and in 1999 Dr. Osorno published his first series of 110 cases in Plastic and Reconstructive Surgery, the most recognized plastic surgery journal in the world. Up to now Dr. Osorno has performed 540 reconstructive surgeries on 490 patients in Colombia.
In Colombia, as in all parts of the world, there are congenital deformities which are studied and treated. For instance outer ear malformations, also known microtia (small ear) are the most frequent, and according to the World Health Organization (WHO), occur once every 8,000 births.
Outer ear reconstruction can be performed starting from 6 years of age, when the ear is approximately 80 to 90% the size of a normal adult ear and can maintain a lasting symmetry for the rest of the growth period. This surgery can also be carried out in adults.
“The procedure is often more simple for children, as adolescents and adults have slightly more rigid cartilage, but reconstruction is always possible. If a patient has a disease, such as diabetes, a kidney or heart condition, it can pose a risk during the operation,” said Osorno.
In the early 1980s, American Physician Burt Brent published his experience in outer ear reconstruction with rib cartilage, which showed greater aesthetic quality. By then Dr. Osorno began to work with this technique.
Reconstruction of the outer ear flap is comprised of four surgical procedures, as suggested by Brent. Once the cartilage has been extracted; it is carved and assembled to make up an ear of the same size and form of a normal ear. Segments are then joined by sutures. Then an incision is practiced on the defective area of the patient’s ear and the cartilage is also extracted; then they make a “skin pocket” where the carved cartilage graft is inserted.
They place the ear symmetrically in position in relation to the other ear. Later they introduce a thin drainage tube, which is connected to a plastic container which suctions the accumulated blood. This guarantees that the skin will tightly adhere to the carved cartilage.
The remaining three surgeries should be carried out in intervals no less than three months apart. In the second surgery the ear lobe is accommodated, almost always wrongly positioned on the microtia. The third surgery reconstructs a hole which simulates the ear canal; and during the last intervention the ear is separated from the head using skin graft.
Auricle reconstruction with cartilage graft is still considered a complex procedure which has particular issues and only a few surgeons can achieve satisfactory results. “Carving is performed with a scalpel in order to reproduce the high and low portions of the ear, which must be carried out in accurate proportions to obtain satisfactory results,” he said.
Due to the high quality this surgery demands, researchers have developed alternatives such as reconstruction using porous polyurethane ears using an inert and biocompatible material, which is an advantage because thorax surgery is not necessary. But taking into account that the implant is artificial, it gradually thins the skin that covers the ear due to constant rubbing, until the skin is exposed, losing the reconstruction process.
Another alternative is reconstruction using external silicone prosthesis which is fixed to the auricle area using titanium screws implanted in the skull. This prosthesis must be removed daily for hygiene reasons and should be changed every two to three years due to material and color deterioration.
“This is not an option for children and youngsters, due to the psychological implications and the potential limitations, but on the contrary it is an option for older cancer or amputee patients.
Outer ear reconstruction using rib cartilage is currently the most used technique around the world. Being live tissue from the own patient it offers greater perdurability and comfort.
The foundation of this procedure is use of costal cartilage, particularly from the sixth, seventh and eighth ribs. Its extraction does not produce adverse consequences for thorax movement, just a slight transverse scar and on occasion an inconspicuous sinking of the area during forced respiration.