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Auricular Reconstruction of a Child’s Ear: Phase 2

Two images showing the side view of an ear reconstruction. Image one shows a wedge of cartilage inserted behind the ear. Image two shows a skin graft used to cover the insertion site.

Your child’s outer ear (auricle) is missing or underdeveloped (called microtia). Surgery can be done to build your child an outer ear. The surgery is done over several phases. The exact details of each surgery and the number of surgeries needed depend on the surgeon, and on the structures present in your child’s ear. The basic goal of phase 2 is to move the earlobe into the correct position and to raise the cartilage framework. These steps may be combined into one procedure. Or, they may be done separately. Read on to learn more about this surgery and what to expect. Often, microtia occurs with varying degrees of hearing loss. Your child's hearing loss may be corrected at a later time through different treatments.

A multi-step process

Auricular reconstruction is done during 3 or more surgeries. Phase 2 is often done about 3 to 6 months after phase 1 is completed. This gives the child time to heal from the first procedure. Another 1 to 3 procedures are then needed to make a new outer ear. Your surgeon can tell you more.

Preparing for phase 2 surgery

Prepare your child for the surgery as you have been told. Tell the doctor about all medicines your child takes. This includes over-the-counter drugs. It also includes herbs and other supplements. Your child may need to stop taking some or all of them before surgery. Also, follow any instructions you’re given for preventing your child from eating or drinking before surgery.

The day of surgery

The phase 2 surgery takes about 2 to 3 hours. Your child may need to stay in the hospital afterward. Or, he or she may go home the same day. Before the surgery begins:

  • To keep your child from feeling pain during the procedure, he or she is given general anesthesia. This puts your child in a state like deep sleep through the procedure.

  • When your child is asleep, an IV line is put into a vein in your child’s arm or hand. This line delivers fluids and medicines. A tube is then passed through your child’s mouth into the trachea (windpipe) to help with breathing during surgery. Special equipment monitors your child’s heart rate, blood pressure, and oxygen levels.

During the procedure

  • First, the earlobe is moved. Incisions are made in the skin over the cartilage. Flaps of skin are created. These are pulled together to move the earlobe into the correct position. Any excess skin is removed. The incisions are then closed with sutures.

  • Then, the ear is lifted. A curved incision is made behind the ear. A wedge of the child’s cartilage is then placed below the cartilage framework. This lifts the new ear slightly off the head. The wedge is covered with a flap of tissue. This tissue flap is taken from the back of the normal ear or from the scalp. Then a skin graft is used to line the back of the ear. The skin graft is taken from the groin area, hip, buttocks, or upper arm. A special dressing is placed behind the ear to hold the skin graft in place as it heals.

  • One or more tubes (drains) may be placed near incisions. This drains any fluid that builds up in the area after surgery.

Recovering in the hospital

When the surgery is complete, your child will be taken to a room to wake up from the anesthesia. You may be able to see your child at this time. Your child will be monitored as he or she rests. Pain medicine can be given if needed. If your child needs to stay overnight, you and your child will then be taken to a hospital room. You will be told when you can take your child home.

Recovering at home

Once home, follow any instructions you are given for caring for your child. During your child’s recovery:

  • Give prescribed medicine as instructed. Even if your child doesn’t complain of pain, give the medicine on time. Do not wait for the pain to get bad. (This makes the pain harder to control.)

  • Do your best to prevent your child from touching the ear. Don’t allow siblings or other children to touch your child’s ear or play roughly around your child as he or she heals.

  • If your child is sent home with a drain in an incision, follow the instructions you are given for how to care for it.

When to call the doctor

Be sure you have a contact number for your child’s doctor. After you get home, call if your child has any of the following:

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

  • Bleeding or a large amount of drainage from an incision

  • Symptoms of infection at an incision site such as increased redness or swelling, warmth, worsening pain, or foul-smelling drainage

  • Any injury to the ear

Follow-up

Take your child for scheduled follow-up visits. During these visits, the doctor will check to make sure the ear is healing properly. At this time, you and the doctor can schedule any further surgeries needed to repair the ear.

Risks and complications

All procedures have risks. The risks of this procedure include:

  • Bleeding

  • Infection

  • Risks of anesthesia (you will discuss these with the anesthesiologist)

  • Dislike of how the ear looks after surgery

  • Extrusion (cartilage wearing through the skin)

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