Royal Free London NHS Foundation Trust
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Plastic and reconstructive surgery
Plastic surgery

Ear reconstruction service

The plastic surgery ear reconstruction service is led by Mr Walid Sabbagh and Mr Greg O'Toole, consultant plastic surgeons.
Mr Walid Sabbagh, consultant plastic surgeonMr Greg O'Toole, consultant plastic surgeon

Ear reconstruction is considered as one of the most challenging operations in plastic surgery. It is usually undertaken in specialist centres, where, with the appropriate training and case availability it is possible to attain excellent results. The majority of plastic surgeons see 1-2 cases per year. In view of the rarity of the condition specialist centres such as the Royal Free Hospital have developed to provide a national tertiary referral service. Ear reconstruction is requested by two main groups of patients: those who have an underdeveloped ear at birth (a condition known as microtia) and those who have lost a normal ear through trauma, disease or previous surgery.



Microtia example Microtia example Trauma example
picture of Microtia example picture of Microtia example picture of Trauma example

The reconstruction process is in two stages, about 6-12 months apart. The first stage involves creating a skin pocket at the site of the ear by re-orientating the available tissue and thinning the skin to mimic the ear skin. Rib cartilage is then harvested in three pieces. These are carved and wired together with fine stainless steel wire to produce a very detailed ear framework. The framework is then inserted in the pocket and gentle suction is applied to enable the skin to adhere to framework. This operation takes 4-6 hours and the expected length of stay in hospital is 5-7 days.

The second stage involves releasing the ear from the head and inserting a piece of cartilage behind it to maintain projection. A flap of vascularised tissue is then utilised to cover the exposed cartilage. This is either transposed from behind the ear or rotated from under the scalp. This is then covered by a skin graft (taken from the scalp, thigh or groin). The second stage takes 3-4 hours and the expected hospital stay is 2-3 days.

For congenital ear abnormalities (microtia), surgery is usually deferred until the age of nine or above. This because prior to this age there is generally insufficient volume of rib cartilage that needs to be harvested for the reconstruction. This operation can be performed at any age in adulthood although it can be more difficult in the older age group because of cartilage calcification. The psychological benefit of ear reconstruction to the patient is immense. Prior to reconstruction most of the children are withdrawn, lack confidence and suffer from teasing at school. Adults are also affected in a similar manner following ear loss.

The operation has a high success rate with over 90% of the reconstructed ears being graded good/excellent by our patients. However, in patients who have significant scarring or a low hairline, more complex techniques may need to be used (see the gallery for examples). It is therefore recommended that all patients requiring ear reconstruction be referred to a specialist in the field.

The alternative to autologous ear reconstruction is a prosthetic ear (Branemark). This is clipped on to two titanium pins inserted into the skull. There are pros and cons to each method. The disadvantages of prosthetic ear are that it needs to be removed daily for cleaning, it can be accidentally unclipped from minor trauma, frequently complicated by problems around the pins throughout life and suffers from poor colour match. The advantage is that it is a simpler operation compared with autologous reconstruction.

Microtia example
before surgery
Before
after surgery
After
after surgery
After
before surgery
Before
after surgery
After

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page last reviewed: 29 April 2010