Our preferred method of ear reconstruction is the Firmin technique.
This is a two-stage technique. Because cartilage needs to be used to construct the ear the child
must be at least 8 years of age to have sufficient cartilage available.
The second stage is performed at least 6 months after the first stage. The aims are to create a post-auricular sulcus and to elevate the framework. Contra-lateral ear pinning is sometimes required for the contra-lateral ear.
The second stage involves elevating the framework by placing a cartilage piece (banked from first stage) behind the anti-helix deepening the concha and creating a sulcus. The second stage involves one of the following methods as per Firmin Classfication.
Type A: Split skin graft posterior to the framework
Type B: Temporoparietal fascial flap behind the framework
Type C: Random fascia
Type D: Firmin design of tunnel beneath the anti-helix and scalp skin graft
At times another third procedure may be required to refine the result.