Where it is deemed necessary to fix the cartilage in this way, the author advises to remove an elongated elliptical piece of the concha, as shown in [Fig. 140].
This is neatly done by outlining the section with the scalpel, and excising it with the aid of a fine pair of scissors, half rounded; the operator holding the index finger of the left hand in the depression of the concha anteriorly as a guide to avoid injuring the skin.
After the elliptical exsection a linear incision with the scissors may be made both superiorly and inferiorly to further mobilize the springy shell of the ear, which will then be found to fall easily into place.
The bleeding in the latter method is more severe, since the posterior auricular arteries and the auricular branch of the occipital have to be severed, yet ligation is rarely necessary.
The interrupted suture may now be applied, varying the site of puncture as below or above its fellow puncture, as made necessary by the droop of the ear, with the object of shifting it into a normal position; or in other words, by raising or lowering it upon tightening the sutures.
The continuous suture is to be preferred, however, when the cartilage has been removed as described, since the ear has now become quite mobile and is easily placed in position.
When the removal of these sutures, which should be of Nos. 5 or 6 twisted silk, is considered, one can comprehend the advisability of this form of wound closure.
The ear will now appear to lie quite close to the head, compared with the original position, as shown in [Figs. 141 and 142].
The patient is now turned so as to present the other ear, a pad of gauze and absorbent cotton being placed under the ear operated on for comfort’s sake.
The second ear is operated as was the first, the operator having taken note of the form and size of the incision of the ear just finished.