Rib Graft surgery is the gold standard for reconstructing an outer ear and has been available since the 1920’s. Rib Graft surgery utilizes the body’s own biological materials to create an ear framework using rib cartilage and a series of skin grafts. The rib graft technique is achievable between 2 and 3 separate surgery stages where the ear framework is sculpted and stitched together, then tucked into an incision in the scalp, and then eventually elevated away from the head to give the ear projection. A newly reconstructed rib graft ear requires time to heal in between surgery stages and can take up to a three month period each time.
Drs. Ron Eavey and Scott Stephan offer two rib graft surgical techniques, the Brent Technique and the Mahatma Technique. Six years of age is the minimum age that Drs. Eavey and Stephan offer the 3 step reconstruction option with rib cartilage. Eight years of age is the minimum age for the 2 step reconstruction option with rib cartilage. While Drs. Eavey and Stephan offer 2 and 3 stage surgical options, the number of stages may vary from patient to patient and can help with scheduled out surgery that works for your child.
Stages of Rib Graft Surgery:
Stage 1 – The first operation consists of retrieving rib cartilage from three sections of rib through an incision that is made in the lower rib cage. The incision made to retrieve the rib cartilage is usually between a 1 inch and 2 inch long incision. Once the rib cartilage is available to work with, the ribs are carved, sculpted, and stitched into the shape of an ear framework. An incision is then made in the scalp (where the ear would normally exist) and the framework is then implanted under the skin. Spare cartilage can be banked in the scalp to use later if necessary and also for being used behind the ear for projection.
Stage 2 – The second stage is where the existing Microtic ear tissue is manipulated and rotated from the current Microtia ear site and then used to create the ear lobe.
Stage 3 – The third stage is where the newly reconstructed ear is then released from the head and elevated to give projection for the ear (where the ear stands away from the head, creating a functional space for eyeglasses). Any extra rib cartilage that was originally banked in the first stage of surgery can be utilized for helping create projection for the ear. During this same stage the Tragus (the tab in front of the ear) is also created.
Today, pain management is very easy for the patient during both surgery and following surgery. Anesthesia can be administered via an epidural by an anesthesiologist who does this routinely at the Children’s Hospital. After a few days, over the counter pain medication can be given to help alleviate pain. Any pain experiences usually subsides after a couple of weeks.
Some advantages of the rib graft procedure are:
- the tissue is not rejected since the patient is the donor source and the rib can be implanted directly under the skin (without the need for a flap from the side of the head such as with a Medpor or Su-Por ear framework).
- the ear requires no hygiene maintenance since it is beneath normal skin tissue (i.e., the skin is easily washed and suntanned automatically unlike a prosthetic ear).
- a full-sized ear can be created since a large amount of tissue is transferred for reconstruction.
Some disadvantages of the rib graft procedure are:
- more than one stage is necessary
- the first stage is uncomfortable for a few days at the rib harvest site
- the ear will be slightly stiffer than a normal ear with some flexibility
- the donor sites will have visible scars (on the chest for the rib and at the skin graft donor site).
To make an appointment, e-mail us at: MicrotiaAtresiaClinic@VUMC.org or call ph: 615-343-6166.