Surgeons use woman’s own tissue to rebuild ear lost to cancer

Cartilage model placed under forearm skin to grow new covering
October 1, 2012
ear_reconstruction

After removing pieces of rib cartilage to assemble a new ear, surgeons implanted it under the patient’s forearm skin for four months so that skin could stretch and grow around it (credit: Johns Hopkins Medicine)

Surgeons at Johns Hopkins Medicine have successfully created a new ear for a woman who lost one of her ears to an aggressive form of skin cancer.

The reconstruction required six operations over a period of 20 months, beginning in January 2011. It is one of the most complicated ear reconstructions ever performed at Johns Hopkins, according to surgeons involved in the case.

The patient’s left ear and part of her skull were removed to spare her life after a recurrence of basal cell carcinoma in 2010.

Piecing together more than a dozen bits of bone, cartilage, skin and arteries, doctors rebuilt the patient’s ear Doctors constructed a new ear using rib cartilage, shaping it to match her other ear, then implanted it under her forearm skin for four months so that skin could grow around the ear. They also inserted a bone-anchored hearing aid to restore her hearing.

All living tissues were taken from spare or renewable parts of her own body to minimize the risk of rejection by her immune system. ”It’s my skin, my bone, and the most realistic surgical replacement to what my ear was before my cancer,” says Sherrie Walter, a working mother of two whose ordeal began in 2008 with the scab that “just didn’t heal.”

Lead surgeon Patrick Byrne, M.D. says Walter’s reconstructive options were few, as her cancer surgery had removed the surrounding and underlying skull bone structure needed to support more traditional options, such as a re-attachable, plastic prosthetic ear.

Aiding Byrne in the January 2012 surgery was an intra-operative laser, with a low-enough frequency to penetrate skin without burning it, yet high enough to visualize the ultra-thin blood vessels inside the ear. With it, Byrne was able to assess if the new ear had sufficient blood flowing through it and where. He then affixed three of the largest of the hard-to-find blood vessels — one artery and two veins — in the newly attached ear to matching blood vessels in the head.

Byrne, an associate professor in otolaryngology-head and neck surgery at the Johns Hopkins University School of Medicine, praises Walter’s commitment to her recovery.

“Patients must have the physical and emotional courage, and the patience, to deal with these exhausting procedures, and to recover and re-energize so they can proceed from one surgery to the next,” says Byrne, who is also director of facial plastic and reconstructive surgery at Johns Hopkins.