43. Microtia continued: A useful kit to practice carving
An average plastic surgeon treats cases of microtia only occasionally but those whose practice includes a larger volume have realized over the years that it is the carved cartilage that mainly decides the end result and that carving needs practice. In the past material such as soap, putty, clay or potato have been used for carving. But there are disadvantages to these materials for e.g. the carved pieces cannot be preserved, are difficult to modify and the draping of skin over the cartilage, a very important step, cannot be simulated over these materials. Dr. Francoise Firmin of France, a leading figure in the surgery for Microtia (Fig. 1 and 2) has devised a kit (Firmin Trainer® Karl Storz) with a plastic base and uses polystyrene (thermocole) as the carving material.
The kit also uses a biological glue to fix different carved parts and uses a well fitting latex cover over the plastic base into which a suction tube is incorporated (Fig. 3). Once the fixation of the carved parts is over with the biological glue, the latex cover is applied and a 60 cc syringe is used to effect suction (Fig. 4).
One can then view the result that the carving and the snugly draped skin (in this case latex) produces. Parag Telang, an aesthetic plastic surgeon from Mumbai who trained under Dr. Firmin practices this method regularly and carves frequently in his spare time to improve his results and has kindly sent this material which elaborates on this technique. This material was presented at a recent meeting at the Nair hospital in Mumbai, India during a workshop on Microtia (January 2014).
He makes the point that beginners usually lose sight of the fact that both the helix and the anti-helix are three-dimensional structures and so are the tragus and the anti-tragus, the latter a little less prominent (Fig. 5).
He has observed that the gutter between the helix and the anti-helix needs to be a little wider when the cartilages are positioned because the skin dips into this concavity due to the suction and the resultant force then provides adequate vertical depth so that the helix and the anti-helix will stand apart distinctly without getting approximated too closely (Fig. 6).
He has also kindly submitted illustrations to show the improvement in his own results from before when he started carving on the Firmin Trainer® (Fig. 7 and 8).