The incision should involve the skin only, and vary from three fourths to one half an inch from the outer border.
At once the blood will ooze from the line of incision. The operator now presses the ear backward on the bare skin of the head, leaving an imprint of the bleeding line on the skin there.
A second incision is made along this line, giving the total outlining incision a heart-shaped form, as shown in [Fig. 139].
The skin within this area is now dissected up quickly. There will be more or less bleeding from the post-auricular vessels, which can easily be controlled by sponge pressure, or with one or two artery forceps of the mosquito-bill pattern. The wound should be large enough to overcorrect the fault, as the ear springs out more or less when healed.
Sutures are now introduced. When necessary one or two catgut sutures are taken through the concha, not going through the anterior skin, however, and the deeper tissue back of the ear and tied. These hold the cartilage in place.
Fig. 139.—Author’s method.
Fig. 140.—Cartilage to be Removed. (Author’s method.)
For the coaptation of the skin the continuous suture is to be preferred, but when the cartilage suture is employed it will be found impracticable, owing to the close position of the ear to the head. In that event interrupted sutures must be placed, as shown in the Monks operation, and tied after the cartilage has been fixed as described.