Carving an Auricular Framework

The framework should be as delicate as possible and about 3 mm smaller than the film pattern in all dimensions (see Fig. 10.13). The block from which the main framework is carved may be obtained from the ipsilateral side (Weerda, Nagata: operative side, easier access) or from the contralateral side (Brent, Siegert) (Fig. 11.3a, b; see also Fig. 11.1). Instruments: The instruments for framework fabrication consist of No. 11 and No. 15 scalpel blades, special sharp gouges (see Fig. 2.7a, 7) 2-5 mm in width, 5-0 wire suture material, and 5-0 braided absorbable sutures (e.g., Vicryl [Ethicon, Germany]) on a P3 (Ethicon, Germany) needle. The framework is carved 3 mm smaller than the pattern. In most cases, all of the main framework can be fabricated from the sixth and seventh ribs (Fig. 11.3a-c), otherwise it must be assembled from smaller segments. The helical rim is carved separately from the eighth (or ninth) rib, which should be at least 8-9 cm long (Fig. 11.3d). The rim should be 8-10 mm wide and is affixed to the main framework with doubly armed wire or absorbable suture material (4-0 or 5-0 on straight needles) (Fig. 11.3e).

Fig. 11.2 "Balanced" cartilage grafts designed by Gibson and Davis (1957).

a Grafts of various shapes cut from the center of a rib. b Nasal dorsal onlay graft from the ninth rib. c Graft shape can be stabilized by sewing together two pieces of cartilage that have opposite warping tendencies.

Fig. 11.2 "Balanced" cartilage grafts designed by Gibson and Davis (1957).

a Grafts of various shapes cut from the center of a rib. b Nasal dorsal onlay graft from the ninth rib. c Graft shape can be stabilized by sewing together two pieces of cartilage that have opposite warping tendencies.

Preparation of Cartilage Grafts 119

Fig. 11.3 Fabricating a cartilage framework for total auricular reconstruction (generally left side thorax for a left auricle). a, b The pattern is placed on the exposed cartilage: A, the posterior side of the cartilage for an ipsilateral reconstruction (A); the anterior side for a contralateral reconstruction (B; see Fig. 11.1). Synchondrosis between the sixth and seevnth ribs (arrow).

c The main framework for a left ear (about 3 mm smaller than the proposed auricle). Arrow: synchondrosis. d Helical rim carved normally from the eighth (or ninth) rib, 9-10 cm long. e The helical rim is attached to the main framework with 5-0 wire sutures and/or 4-0 Vicryl (Ethicon, Germany) sutures (doubly armed, straight needles). Arrow: synchondro-sis.

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