Which should be done first, outer ear repair for microtia or canal and middle ear surgery for function?
If the surgeon has the ability to carve a good ear framework from rib cartilage, the outcome of microtia repair is largely determined by virginal, unscarred skin in the ear region. Repairing microtia by constructing the outer ear first does not impede atresia repair and canal surgery, but the opposite is not true. If the canal is created first, the skin is usually no longer suitable for microtia repair; the surgeon is likely forced to use a fascial scalp tissue “membrane” flap (with all of its liabilities) instead of the original, invaluable virginal skin to cover an ear framework.
