Auricular cartilage can be harvested using the anterior or posterior approach (1-6). In most cases, we prefer the anterior approach because we believe it is less traumatic, and the incision heals well if vertical mattress closure is used. If smaller cartilage grafts are needed, then we use the posterior approach.
With a marking pen, outline an incision that follows the outer edge of the cavum and cymba concha. This incision should he placed along the portion of the concha that is vertically oriented in relation to the lateral aspect of the skull (Fig. 1). Use a syringe with 1% lidocaine (Xylocaine) solution with 1:100,000 epinephrine (or for the lab demonstration, water) to “hydrodissect” the skin of the concha cavum and cymba from the underlying cartilage.
Make the incision with a no. 15 blade, and elevate the skin and perichondrium from the underlying cartilage. Dissection proceeds by using appropriate scissors, and also bluntly with cotton-tip applicators. Care should be taken not to damage the soft auricular cartilage, which can tear. The dissection should stop short of the cartilage of the external auditory canal. The radix helicis should be preserved if preservation of ear position is critical. If the entire conchal bowl in excised, the auricle will usually settle closer to the head.
Dissect out the desired piece of cartilage, and leave the underlying muscle behind (perichondrium will remain adherent to the posterior surface of the cartilage). Avoiding deep dissection into the soft tissue minimizes bleeding.
Suture the circumferential incision with a 6-0 nylon running mattress suture. Alternatively, the incision may be closed with interrupted vertical mattress sutures. Special care must be taken to avoid overlap of the skin edges. Place a bolster dressing of Telfa, dental roll, or other suitable material into the concha, and suture it into position to decrease the risk of hematoma. No residual deformity of the pinna is expected with this approach.
Figure 1. A-T: Injection hydrodissects the skin of the concha cavum and cymba from the underlying cartilage (A). The incision follows the outer edge of the cavum and cymba concha and is placed along the portion of the concha that is vertically oriented in relation to the lateral aspect of the skull (B, C). Dissection proceeds by using appropriate scissors, and also bluntly with cotton-tip applicators (D—G). The dissection stops short of the cartilage of the external auditory canal. Incise the cartilage (H, I) and dissect out the desired piece of cartilage (J, K). Achieve perfect hemostasis before closure (L). The cartilage should be handled gently to avoid tearing or damaging the soft auricular cartilage. Suture of the circumferential incision is shown here with a 6-0 nylon running vertical mattress suture (M-P). Alternatively, one may close the incision with interrupted mattress sutures. Place a bolster dressing of Telfa, dental roll, or other suitable material into the concha and suture it into position (Q-T) to decrease the risk of hematoma.