Costal Cartilage Reconstruction

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.

First Stage

  • Involves creating a template model of the ear to be reconstructed based on the contralateral ear or a family members ear if bilateral Microtia (photo 1 & 2).
  • The template is then extra-polated to the location of the desired ear position
  • The Surgical incision is then chosen based on the Firmin Classification (photo 3)
  • The ear skin pocket is created
  • Rib cartilage is then harvested from the same side
  • The rib cartilage is sculpted and carved to represent the ear contours
  • A base, helix, anti-helix and tragus-anti-tragus complex is sculpted creating a 3D ear framework
  • Projection pieces are also added as per Firmin technique
  • The framework is then placed under the skin pocket
  • Any remaining cartilage is banked back in the chest for the second stage

Second Stage

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.

Watch The Ear Reconstruction Video

Watch The Ear Reconstruction Video