A GROUND-BREAKING, 4½-hour operation to construct and then surgically attach ears for a little girl who was born without them was performed at the Port Elizabeth Provincial Hospital yesterday.
The complex operation on seven-year-old Naledi Alset, of Walmer Township, involved a medical team of 12 people and was one of 32 life-changing procedures to be performed on Eastern Cape children under the banner of the Smile Foundation until the end of this week.
In what was described as "highly exceptional" surgery, Naledi received two new ears that had been sculpted from her rib cartilage.
Naledi's mother, Judy, burst into tears when shown pictures of her daughter with her new ears.
Plastic surgeon and head of the Port Elizabeth Hospital Complex's Burns Unit, Dr Chris van der Walt, was one of four surgeons involved in the operation.
Naledi was born with no ears and a cleft palate. Her cleft palate was corrected a few years ago.
Van der Walt said operations to reconstruct ears could only be done on older children, as younger ones did not have enough rib cartilage.
"I have been waiting seven years for this day," Judy Alset said.
"When Naledi woke up this morning she told me, 'Mommy, when I come out of the hospital we must go buy me ear rings'."
Van der Walt said East London plastic surgeon Dr Tim Perks had specially come to Port Elizabeth for the operation.
"I asked him to help us as he has a skilful, artistic hand and you need someone like that to make ears for a little girl," he said.
The surgery was done in two parts. First, rib cartilage was harvested from Naledi's ribcage.
The cartilage was then fashioned into new ears by Perks before being attached to her head. It was then covered with a flap of skin.
Van der Walt said the surgeons also stored two tiny pieces of cartilage just under her skin for follow-up surgery.
"We don't want to take it from the ribs again as the harvesting of cartilage is very painful," he said.
"In follow-up surgery, we will take these small pieces of cartilage and wedge them behind the new ears to prevent the ears from folding back."
Van der Walt said the first ear reconstructions were done in the 1980s, but surgeons first experimented with other materials.
"The body eventually rejected all these different materials. Now we use rib cartilage," he said.
Eastern Cape plastic surgeons had reconstructed one ear for children before, but this was the first time they had sculpted both ears. There were a variety of reasons why children needed ear reconstructions.
"Some, like Naledi, are born without ears. They can hear as their inner ears are complete but they have no outer ears. Others lose their ears during trauma. "This is a highly exceptional operation," Van der Walt said.
Dr Ronel Gower and Dr Michael Rebiro carefully harvested Naledi's rib cartilage while veteran anaesthetist Dr Cathy Ives and her intern doctor, Chandre Marais, kept a watchful eye on the machines.
As Naledi needed two ears, Gower and Rebiro had to harvest cartilage from both sides of her ribcage.
The tiny slivers of cartilage were then handed to Perks who painstakingly carved ears for the little girl using a scalpel.
"We do try to do this as quickly as possible as it is always risky to have a patient under anaesthetic for that long," Perks said.
He then attached the ears to the little girl's head and when the cartilage formed a perfect little ear once it was covered with skin, Sister Pat Neill, who assisted Perks, exclaimed: "It is like magic."
The six-strong nursing team could not contain their smiles in the theatre as the surgery progressed.
"This is always a good week for us," Sister Nolukholo Kahla said.
"You go into surgery hearing all these stories of the children being teased but the best is when they come out and they are all fixed up."
Rebiro, who is attached to the Wits University faculty of health sciences, will be assisting with several Smile Foundation surgeries this week. Alset, who lives with Naledi's father, Mzandilo Nondalo, said her daughter was very outgoing.
"She was so excited about getting new ears. Naledi is a busy little thing and for the past few days all she could talk about were new earrings," her mother said.
Smile Foundation operations executive director Moira Gerszt said the organisation tried to help children with facial anomalies such as cleft palates or damage from severe burns.
"We help all children from birth to the age of 18 with any type of surgery that can help them," Gerszt said.
It is the fourth Smile Foundation week to be held in Port Elizabeth.