This case involves an eight-year-old boy that presented to a plastic surgeon to cosmetically repair a deformed ear and have ear tubes implanted. The plan was for the surgeon to place an implant and rebuild the structure of the outer ear, but the surgery was met with significant complications. Immediately after surgery, the patient’s parents attempted to schedule a follow-up appointment, but the surgeon was not available to see them until six days after the procedure. By this time, however, the implant was no longer salvageable because of an infection. Due to the infection, the child’s ear was significantly worse than before the procedure, and the patient required additional procedures to repair the damage.
Question(s) For Expert Witness
- 1. What are the indications and contraindications of this procedure?
Expert Witness Response E-000629
Ear reconstruction is indicated when a child with microtia has reached sufficient age, which may be between three and six-years-old. The latter age is typically recommended for rib cartilage reconstruction because sufficient time must be allowed for the normal ear to reach most of its adult size and act as an accurate template for the ear to be reconstructed. In addition, the costal cartilage will achieve sufficient size to provide adequate donor material for the framework. Auricular reconstruction using costal cartilage probably is not indicated for patients with limiting anomalies in other parts of the body. Other contraindications include lack of graft material in patients with previous cartilage harvest, patients with poor skin quality in the auricular area secondary to burns or previous surgery, and patients who are poor anesthetic risks.