Rib Graft FAQs

* This information was gathered by directly speaking with surgeons, families and individuals who have already had surgery, and through personal research including attending surgical conferences directly related to Microtia ear reconstruction. The remaining information has come from noted sources.

What is the youngest age a child can have Rib Graft?

Five years of age. Although, the “Brent” surgical technique prefers to wait until 6 or 7 years of age. The “Nagata” technique prefers to wait until 10 years of age. Depending on the surgeon performing the surgery, ages to begin Rib Graft may range from ages 5 to 10 years of age.

How many surgeries are needed for a Rib Graft ear to be reconstructed?

Typically, today Rib Graft surgery can be achieved in 2 to 3 procedures (depending on the surgical technique and other related patient challenges for the surgery) where previously Rib Graft would be achieved anywhere from 5 to 7 surgeons. Some surgeons today can perform Rib Graft surgery in just 1 stage.

How much do you have to weigh for Rib Graft surgery?

It is not the weight of the patient that is a requirement for Rib Graft surgery. Below are the responses from two well respected Rib Graft surgeons (Dr. Burt Brent and Dr. Arturo Bonilla):

November 7, 2011

Dear Melissa,

The weight has nothing to do with when a child is ready for a rib cartilage graft. There are four-year-olds who weigh more than the average six-year-old due to obesity. The issue is more one of having sufficient rib cartilage to do the sculpture and secondly, having the little patient emotionally mature enough to be cooperative during postoperative care for such things as changing bandages and removing of sutures. These are the issues that governs my thinking about waiting until age six.

With kind regards.

Sincerely yours,

Burt Brent, M.D.

November 6, 2011

Hi Melissa,
It is not so much the weight that would finalize the decision to proceed with the reconstruction. You can have a very tall child that may actually be skinny and of lower weight compared to a 5 year old “80 pounder” that is actually low in stature. I like to actually see the children (if possible) before determining the decision to proceed. If they are from outside the state or country, then pictures are e-mailed to me along with height and weight.

I hopes that helps.
Arturo

Can I give my child my ear?  No.

If a surgeon were to transplant your ear on to your child’s body, the ear would quickly become rejected. The body would recognize “your” ear as a foreign body and begin attacking it immediately and the ear would be rejected and die. God knows we all wish we could give our children our own ears. If things were only this easy.

What could cause Rib Graft surgery to be delayed?

Rib Graft surgery can be delayed for a couple of reasons: fever or an immune system attack such as a cold, flu, other virus or sickness. Also, immunodeficiency problems such as a problem with the kidneys or any other organs.

How do surgeons know how to make an ear a certain size?

At birth, a child’s ear is 66% of its adult size. At three years of age, an ear is 85% the size of an adult ear. At six years of age, an ear is 95% the size of an adult ear. An ear’s average “normal” height is 5.5-6.5cm. When reconstructing a Rib Graft ear, surgeons purposely make the newly reconstructed ear smaller in size so that it can continue to grow with the body as the child continues to grow. If an adult has Rib Graft surgery, the ear is made to match non-Microtic ear as close in exact size as possible. Skilled Microtia reconstructive surgeons are very good at guesstimating the size. If too large of a piece of rib cartilage is used it is possible the earl will continue to grow to be larger than the non-Microtic ear. Also, surgeons who specialize in Microtia reconstructive surgery know the perfect thickness of cartilage to shape and use for the ear’s framework. If too much rib cartilage is used, the ear may look thick or bulky in appearance.

Will a Rib Graft ear continue to grow?  Yes.

The rib cartilage that the ear is constructed of will continue to grow. Sometimes, a Rib Graft ear can grow larger than the biological ear. However, because surgical technique has improved over the years, a skilled surgeon can make an ear that will not grow in excess. Still, it is very important that you select a surgeon who has performed many Rib Graft surgeries. If the piece of rib selected is too big, it is possible that the newly reconstructed ear may continue to grow larger than the non-Microtic ear. Your surgeon can help provide some insight about this concern.

Does a Rib Graft ear heal, feel pain or bleed like a biological ear?  Yes.

The rib graft ear is constructed of living biological tissues (both of rib cartilage and skin). Nerve endings are still in tact within the skin graft.

Can a Rib Graft ear fracture or become damaged?  No.

A rib graft ear can not fracture. However, yes, a rib graft ear can become damaged. It depends on the extent of damage in order to see if the ear can be repaired. For example, if someone was in a car accident or motorcycle accident and their Rib Graft ear was cut off or severely burned, then the existing Rib Graft ear itself can not be salvaged depending on the damage. In fact, depending on the extent of scar tissue damage during the original Rib Graft ear reconstruction, chances are that you will not be able to have another Rib Graft ear reconstructed. However, you could still have another reconstructed ear through the Medpor technique or look into having a prosthetic ear made.

* This information was gathered by directly speaking with surgeons, families and individuals who have already had surgery, and through personal research including attending surgical conferences directly related to Microtia ear reconstruction. The remaining information has come from noted sources.

Can a Rib Graft ear become infected?  Yes.

A Rib Graft ear can become infected. However, this usually happens following surgery (just as a Medpor ear may become infected). Many things could cause an infection such as: the ear not healing properly in the first place, an infection from a bandage or water, a cut to the ear, etc… However, today these risks are controlled by careful protocols in the OR during surgery and also through follow up visits during post op appointments where the ear is checked on by the surgeon often during the healing stages.

Can a Rib Graft ear die from necrosis?  Yes.

It is possible that a Rib Graft ear can die or be “rejected” by the patient due to skin necrosis (death of the skin). This can happen if the skin graft piece is too thin or not thick enough where there is not enough of a blood supply to keep it healthy and to have it heal appropriately. This same concern can also happen with a Medpor ear, or any part of the body where a skin transplant has been made. It is very important to go to experienced surgeons who have often become specialized or have developed an expertise in Microtia reconstruction. If you select an experienced surgeon, this rarely happens today. There is always a chance for any surgery that this will happen or that infection will occur.

If a Rib Graft ear becomes infected can it be cured?

Yes, but it depends on the extent of the infection. He ear will be irrigated and treated with antibiotics. The ear will have to be monitored. If the infection is not curable, the ear will have to be removed. Another Rib Graft ear will not be able to be reconstructed due to scar tissue from the first Rib Graft surgery. However, the ear may be able to be reconstructed again through the Medpor technique or the patient can inquire about a prosthetic ear.

Where is the skin graft taken for the Rib Graft ear?

The skin graft for a Rib Graft ear may be taken from different areas depending on the surgeon performing the surgery and his/her surgical technique. Some areas that skin grafts are taken from for Rib Graft surgery are: from the buttocks, from the groin, from the scalp, from underneath the upper arms and from the chest area. I was even told by a Rib Graft surgeon that the skin from the back can also be utilized as a skin graft.

Are Rib Graft ears flexible?  Yes.

In fact, you can bend and pull on a Rib Graft ear just the same as a biological ear. A Rib Graft ear will feel stiffer than a biological ear because the ear is made from rib cartilage which is much stronger and sturdier than ear cartilage. However, you can not tell a difference in thickness when looking at the ear(s) as long as the surgeon is experienced at taking the appropriate amount (thickness) of cartilage used to shape the ear.

Does it hurt to sleep on a Rib Graft ear?  No.

It does not hurt to sleep on a Rib Graft ear. A Rib Graft ear really doesn’t feel any different than a biological non-Microtic ea.

What happens if a Rib Graft ear gets sun burned or burned by the curling iron?

The skin will burn and peel just like a biological ear would. The ear will then heal with the skin sloughing off just like any other sun burnt or lightly burned part of the body. However, if the ear experiences severe burns, it depends on the amount of damage. The surgeon would have to take a look at the ear in order to determine if the ear can simply be patched with another piece of a skin graft, which is most-likely what would be done. Even a Medpor ear or biological ear can be badly burned and suffer some disfigurement depending on the severity of the burn and or accident an individual would be involved in.

Will a Rib Graft ear grow hair on it?  Yes.

Some Rib Graft ears grow more hair than others depending on where the surgeon selected the skin graft from. Today, most experienced Rib Graft surgeons have learned where the best areas are to select skin grafts from. Hair texture can range from a light fine coating such as lanugo that is found on babies at birth to courser hair or hair much like what is found on your scalp.

How do you remove hair that may grow on the Rib Graft ear?

Following surgery, the surgeon can laser the Medpor ear in one of the post op appointments. It is strongly suggested to have a surgeon laser the hair and not by a beauty laser consultant or even a dermatologist. The surgeon who reconstructed the new ear knows that ear best. If you are too far to travel back to the surgeon who reconstructed the ear, ask for a referral to someone they may know closer to you that the surgeon can trust with the new ear. Some patients will shave the ear every six months or so.

Will Rib Graft surgery leave a large scar on the scalp?

A scar may be found in the scalp by the ear, but will not be visible as the scalp hair should cover the scar making it unnoticeable. Often times there may be a scar found directly behind the ear.

Will hair grow back where the scalp scar is?  No.

Usually, when there is a scar, hair doesn’t grow back in that area due to scar tissue. Depending on the skill of the surgeon, some surgeons have a smaller incision scar area. Some surgeons may have a scar that looks like a patch where the hair unfortunately not grow back. Again, try and

Will there be any numbness on the scalp where the incision was made for the Rib Graft ear?

Sometimes, there is some numbness associated with the scar on the scalp from where the the incision was made and where the skin graft was taken near the ear. Some patients also experience a “zinging” sensation from the scar due to scar tissue breaking up. There are topical creams and massage that may be able to help alleviate the “zinging” sensation from the scar.

Will a Rib Graft ear come off?  No.

A Rib Graft ear is attached to the head just as a Medpor ear is…both are sewn on and both do not come off. A prosthetic ear can be removed. A Rib Graft ear is not a prosthetic ear. A Rib Graft ear becomes a living part of the body as the skin and rib cartilage used is from the body to begin with and is living tissue. A Rib Graft ear can feel pain, bleed, heal, and will be sensitive to touch.

Can someone with a Rib Graft ear play sports?  Yes.

Someone who has a Rib Graft ear can play all sports. In fact, the rib cartilage used to reconstruct the ear is very strong…much stronger than a biological ear with “ear” cartilage.

Can Rib Graft and Atresia repair (canalplasty) be performed together?  No.

Since Rib Graft surgery is typically achieved in multiple stages it is currently impossible to have both Rib Graft ear reconstruction and canalplasty done at the same time in the same procedure. Even if Rib Graft was performed in one stage (as it is by some surgeons), the duration for surgery time alone would be almost-likely exceed a full 24 hour period which is not suitable for any patient just seeking ear reconstructive surgery.

Can a Rib Graft ear be reconstructed?  No.

A Rib Graft ear can not be reconstructed due to the amount of scar tissue that is created from the surgery itself. Since Rib Graft surgery requires the rib cartilage framework to be inserted into a pocket of skin that covers the ear, there will not be any tissue left to work with for a second chance. However, another ear can be reconstructed through the Medpor technique as long as too much scar tissue doesn’t pose any major challenge. A prosthetic ear is always an option. Depending on the damage of the Rib Graft ear, an anaplastologist may suggest complete removal of what is left of the ear if not choosing to fit the prosthetic ear to the existing portion of the ear.

In the future, can a Rib Graft ear be cut open or altered to have actual harvested “ear” cartilage inserted in place of the rib cartilage?  No.

Once a Rib Graft ear has been reconstructed, the ear can not be altered where the rib cartilage making up the internal framework of the ear, can not be removed as the existing rib cartilage has already become attached to the rib cartilage, growing together as one. An entire new ear would have to be reconstructed for the ear cartilage to be inserted, if it is possible due to the amount of scar tissue created from the Rib Graft ear.

Tips:

– Always do your research on all surgical techniques that exist today and that are on the horizon.

– Always seek more than a couple of medical opinions.

– Just because you have found a surgeon who is down the road from you, may not mean that surgeon will yield a successful surgery.

– Don’t be afraid of insurance coverage. There are ways to appeal and or fund raise. There are also organizations who may be able to help you with surgery. * See my lists of helpful resources and helpful financial resources.

– Do attend a surgical conference if you can so that you can learn as much as you can about surgery.

– Don’t be afraid to ask questions or to ask your surgeon to help you clarify something. Many times, if you are not an adult having surgery, these are our children we are talking about here and we advocate for them as best as we can.

– Nothing man made is ever perfect. However, Rib Graft ears are darn beautiful and amazingly near perfect, depending on the experience of the surgeon you have chosen. They look similar to the biological ear that is not affected by Microtia. The detail is great. Also, many of us would be so happy to have an ear, even if the ear lobe was slightly off or had a little bit of a dimple in it from an incision when compared to having no ear at all. So, even though you may go into surgery expecting a “perfect” ear, perfect is what you will never get…so please do not set yourself up for failure. However, you will be very pleased with a new Rib Graft ear.

– The Rib Graft surgical technique is a wonderful surgical option for ear reconstruction. What is most important is that you choose a surgeon who is experienced or who has chosen to become specialized in Microtia repair as not every surgeon who practices Rib Graft for ear reconstruction yields the most successful results, makes the nicest looking ears, or can show the best quality of work. Please do your research and ask to see lots of “before” and “after” pictures, including ask to speak with past patients so you can see for yourself if you are satisfied with a surgeon’s work. Some surgeons have mastered certain skills that can make the world of a difference in the way the ear looks, how the ear is shaped, how the ear heals (scaring wise), how the color of the skin selected for the skin graft matches in color to the face and other ear, and the quality of the ear depending on how the ear holds up over the years. When it comes to yourself and especially your child, please make sure you have learned as much as you can about the surgery and do seek multiple opinions so you can make the best decision.

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