The second stage operation - auricular projection
Schematic illustration of the second stage operation - auricular projection. Diagram 1: The outline for the second stage operation, auricular projection. The spindle shape outline is for the harvesting of the ultra-delicate split-thickness scalp skin [UDSTS] and the outline along the helical rim is for the release of the reconstructed auricle. The zigzag outline is the incision outline for the elevation of the temporoparietal fascia flap [TPF] with the superficial temporal artery plotted. Diagram 2 and 5: The harvested UDSTS with the area where it was harvested, and the preparation for the elevation for the TPF. Diagram 3 and 4: The method of harvesting the UDSTS with a scalpel [number 15 blades]. Diagram 6: The elevated TPF. Diagram 7: For the release of the reconstructed auricle, the area immediately adjacent to the helical rim which penetrates into the hair-bearing skin is elevated in the same manner as the UDSTS to the distance of 4 mm from the margin of the reconstructed auricle. Diagram 8: The follicular bud layer is left at the site of elevation of the UDSTS portion of the skin cover. Diagram 9: The release of the reconstructed auricle from the site of the head. Diagram 10: The layer with the follicular buds adjacent to the helical rim is to be excised. Diagram 11: The skin of the temporal and mastoid surfaces is undermined. Diagram 12: The TPF is passed through the skin tunnel and the site of elevation is closed. Diagram 13, 14: C4, C5 costal cartilage harvest. Diagram 15, 16, 17: A simplified illustration of the costal cartilage construct with the modification in the inferior portion of the construct, reversed letter L configuration to increase stability. The cartilage block construct is multi-layered, and the units are fixed with 38-gauge wire sutures. Diagram 18: The cartilage block is fixed to the soft tissue of the posterior surface of 3-D frame and to temporal and mastoid surfaces with 4-0 clear nylon. Diagram 19: The TPF covers the top of exposed helix [the UDSTS portion of the skin cover], the posterior surface of the reconstructed auricle, the cartilage block and the temporal and mastoid surfaces. Diagram 20: Skin suture line. Diagram 21: The skin of the temporal and mastoid surfaces is approximated and the excessive skin is excised in a triangular configuration in the hair-bearing skin to avoid dog ear configuration. Diagram 22: The exposed surface is covered with the UDSTS. Diagram 23: The tie-over is performed to keep the UDSTS in contact to the TPF. Diagram 24: Restone foam sponge is cut out to the reconstructed auricle to provide protection. Diagram 25: The illustrated appearance of the patient after the second stage operation.
Before the operation: Another concha type microtia case which at some institution may be classified as a constricted ear instead of a microtia case.
After the second-stage operation: All the detailed features of the auricle have been reconstructed.