A template of exposed radiograph film is produced utilizing the opposite's side "good ear" for the new ear's size. In cases of bilateral microtia one of the parent's ears is used for sizing. A second, scaled down version is then generated from this template to allow for the increased bulk of added tissue beneath the skin.
Proper positioning of the ear's framework is critical to give a normal appearance to the ear. The height of the the prominent rim sits in a horizontal line at the level of the side brow and the lobe is positioned at the level where the tip of the nose meets the upper lip. Using the template, the new ear position is marked on the scalp with an indelible black marker.
The superficial temporal artery (one of the 3 arteries on each side of the head), and its front and back branches, are then drawn in place with a red marking pen.
The planned incision line is drawn on the scalp in the shape of a “Y.” The Y incision is cut down to the root of the hair. This is the proper level for dissecting the superficial layer over the TPF flap (temporoparietal fascial flap) which is thin and pliable. Then the full dissection is completed and the unnecessary cartilage is removed.
The porous polyethylene ear framework then is sized according to the ear template and sutured together. This framework is then inset into the designed pocket on the lower side of the scalp. A back-cut in the skin along the outside hairline allows the polyethylene framework to be firmly sutured into place.
When the proper position is achieved the framework is removed and fitted with a small hemovac drain (a blood recovery device) just inside the prominent rim. Drain and framework together are now placed in the pocket.
The TPF flap is brought down to cover the framework and drain and then sutured.
The temporal scalp is then closed over a fluted drain.
Now the upper one-third of the TPF-flap-covered ear framework is surfaced with a full thickness skin graft. The donor site is covered with a split-thickness skin graft. If bilateral microtia is present then a full thickness skin graft is harvested from the groin area.