This page is designed to tell you what to expect before, during and after your first stage ear reconstruction operation.
What is the operation for?
To build you a new ear, first we need to make an ear shaped framework that can be placed under the skin at the side of your head. Later on, we will do a second operation to make your ear stick out from your head.
Why do I need this operation?
To make the framework, we will need to borrow some cartilage from your lower ribs. The safest way to do this is if we bring you to hospital and put you to sleep.
Preparation
You will be asked to attend the hospital for a pre-operative visit 2-4 weeks before your operation date.
At this appointment you will be visited by the:
Consultant Surgeon – discussion, planning and consent
Specialist Nurse – what to expect before, during and after surgery
Clinical Psychologist – readiness for surgery and coping with change
Pain Nurse and/or Anaesthetist – going to sleep and pain relief
Physiotherapist – moving and breathing exercises after rib harvest
Medical Photographer – photographs and 3D scan
This is the chance for final discussion, planning and information giving with regards to your surgery. You will also have a pre-operative assessment by a Nurse Practitioner to ensure you are fit and ready for surgery.
Please be aware that, with so much to fit in, the visit can take around 2-3 hours.
To reduce the risk of complications during and after surgery, we prefer all patients to be free from coughs or colds. Please contact the hospital in the week before the operation date if you have any concerns. You will also be given a special antiseptic soap to shower with. Currently, we still require our patients to have a COVID swab taken around three days before any operation. The child and family will then be required to isolate until they are due to attend the hospital.
Please make sure you have nothing to eat or drink from 12 o’clock the night before your operation.
You can bring slippers, clothes and pyjamas to wear (preferably loose fitting with a wide opening for your head). You may want to bring a book, magazines or hand held electronic device for entertainment.
You will have your meals provided by the hospital, but bringing in some of your favourite snacks is permitted.
Anaesthetic
Harvesting rib cartilage and making the ear can take up to 7 hours, so all patients need to be put to sleep with a general anaesthetic so that they can stay safe and comfortable. The anaesthetic medicine is usually given through a tube (cannula) placed in the back of your hand. Some numbing cream will be placed on your hand to help make this easier.
What happens when you arrive for your operation?
When you arrive on the ward on the morning of the operation, you will be greeted by nursing staff who will show you to the waiting area. You will be checked in by one of the nurses and you will be visited by the anaesthetist, surgeon.
Consent
We will remind you of the expected outcomes of the surgery but will also discuss the potential risks involved. We will then ask you to sign a consent form confirming that you have understood what has been said, and that you are happy to proceed.
About the operation
Once you are asleep, we will need to pass a catheter (small tube) into your bladder. This means we can monitor your hydration during surgery and avoid you needing to go to the toilet as soon as you wake up. The catheter will be removed before you return to the ward.
The purpose of the first operation is to make an ear shaped framework from rib cartilage and secure it in the correct position. A 7cm cut (approximately) will be made in the skin over the lower rib cage that will allow the surgeons access to the specific ribs needed to create the ear. Once removed, the cartilage will be carved and held together with thin stainless steel wires to create an ear shape. Any leftover cartilage will be placed back where it came from in the chest, so that it can have the chance to re-grow.
A small length of cartilage will be saved and stored beneath the skin on the chest. This may create a temporary bulge under the skin but only until the second or possible third operation when it will be removed and used to make the ear stick out. The wound in your chest will then be closed with stitches under the skin that will eventually disappear. A waterproof dressing will be placed over the wound.
Your existing small ear will likely be adjusted so that it can become a part of the new ear and the skin surrounding this will be loosened to make a pocket for the new ear to be placed in to. This skin will then be closed with stitches that will need to be removed after two weeks. A protective sponge dressing with a removable lid will be placed over the ear that will allow us to perform regular checks without disturbing you too much.
To ensure that your new ear can look as natural as possible, we will need to use a small drain to provide light suction to the skin. This drain is a small, flexible plastic tube about the same thickness as a shoe lace. One end will be placed underneath the new ear, and the other end will be attached to a small plastic bottle. The mild suction within these bottles will allow us to keep the wound dry and ensure that the skin is well positioned. The drain shouldn’t cause any discomfort and you will quickly get used to it being there. This will be removed on the day that you go home.
Before you wake up, the Anaesthetist will give a range of medicines to ensure you are as comfortable as possible and reduce the chance of you feeling sick once you are back on the ward.
After the operation
Once the operation is completed, you will be transferred to a recovery area where you will be allowed to slowly and safely wake up. You will remain sleepy for a number of hours whilst the general anaesthetic wears off.
How long will I be in hospital?
1st stage ear reconstruction normally requires a 4 night stay in hospital. The operation takes place on a Monday with most patients being discharged home by lunchtime on Friday.
Immediate aftercare
After you have arrived on the ward, you are likely to continue sleeping on and off throughout the evening. During this time, you will be asked if you require any pain or sickness medicine and will be given fluids and antibiotics via the cannula in your hand. Once you are able to drink normally, these fluids can be stopped.
Due to the nature of the surgery to your chest, you will find it harder to do simple things like coughing, taking deep breaths, and getting in and out of bed. With some helping hands and lots of encouragement, you will slowly improve, feeling better and more independent as each day passes.
A member of the plastic surgery team and specialist nurse will visit every day to review your ear and monitor your progress.
Once you have been deemed fit enough to go home, the protective sponge and suction drain will be removed. You can have a shower before getting a new sponge and getting dressed to go home.
Care at home afterwards
Once you are at home, it is important that you continue to rest and take regular pain medication as required. You will slowly but surely be able to increase your daily activity, but it will be a number of weeks before you feel back to normal. You will be given advice on what problems to look out for and who to contact if you have any concerns.
Follow-up Care
Most people will need to attend 2 or 3 follow up appointments at the hospital. These will be at weekly intervals with the specialist nurse. This is so we can review your progress and observe how well your wounds are healing. All stitches and dressings are normally removed at the second appointment.
What can go wrong?
As with all operations, ear reconstruction is not without its risks. The most common problems we encounter that require treatment are with the skin over the new ear and the cartilage inside.
These can include:
- skin breakdown – areas of the delicate skin on the new ear can sometimes lose its blood supply, causing it to fail and break down.
- cartilage exposure – if there is skin breakdown or if the skin is difficult to close, sometimes a small area of the cartilage can become visible
- infection – if the skin breaks down or cartilage becomes exposed, there is a chance that the ear can become infected
These problems can occur unexpectedly, but checking your ear regularly and responding quickly should allow us to successfully treat any problems without affecting you or your ear too much.
Another much less common problem can occur during the operation itself. Because the ribcage plays such an important role in our breathing, operating on the ribs has the potential to damage the lining of the lung. This can sometimes lead to air entering the wound, causing a pneumo-thorax or ‘collapsed lung’. On the rare occasion this has happened, we have been able to fix the problem quickly and those patients have enjoyed a full recovery.
Back to normal life
Recovery will be slow but steady. Most people are fit enough to return to school after two weeks, but we recommend that contact sports and swimming are avoided for at least six weeks after the operation.
