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
 

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