CONSENT FOR EAR RECONSTRUCTION

DETAILS OF EAR RECONSTRUCTION EXPLAINED

• Nature of congenital defect
• Options for reconstruction
• No reconstruction needs to be performed
• Bone anchored prosthesis
• Autologous carved rib framework
• Timing of procedure (around the age of 10)
• Risks

DETAILS OF AUTOLOGOUS CARVED RIB FRAMEWORK IN DETAIL

• Staged procedure

1st STAGE

• Procedure
• GA
• 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
• OPA 3/12 to arrange 2nd stage

• Potential risks specifically related to 1st Stage

• Risks of GA (detailed explanation by Anaesthetist)
• Donor
• Scar
• Scar Hypertrophic, Keloid, Stretched
• Pain, Usually improves with time
• Pneumothorax ( Normally ID during op and closed)
• Pneumothorax leading to chest drain (rare) Bruising
• Bleeding
• Infection
• Contour defect
• Recipient
• Scar
• Scar Hypertrophic, Keloid, Stretched
• Pain, Improves with time
• Delayed wound healing requiring return trips to dressing clinic
• Cartilage exposure (rare) would lead to further local 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

2nd STAGE
• Procedure

• GA
• 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

• Potential risks specifically related to 2nd Stage

• Risks of GA (detailed explanation by Anaesthetist)
• Donor- Chest
• Scar
• Scar Hypertrophic, Keloid, Stretched
• Pain, Improves with time
• Pneumothorax is unlikely
• Bruising
• Bleeding
• Infection
• Donor- Scalp
• Skin taken superficial to hair bulbs so alopaecia is very rare
• Hair growth covers healed area
• Bleeding
• Infection
• Recipient
• Scar
• Scar Hypertrophic, Keloid, 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
• Asymmetry

3rd 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
 

<Return to Ear Reconstruction