Antigua, Guatemala
This was Dr. Kolstad’s first trip to Antigua, Guatemala, the beginning of what would eventually become twelve separate missions to the city. It was also his first experience treating microtia, a congenital condition in which children are born with underdeveloped or absent ears. Most commonly, patients have one normally developed ear while the other may only develop as a small lobule.
Reconstruction of the ear is among the most technically demanding procedures in pediatric plastic surgery. To create a new ear, surgeons remove cartilage from four to five ribs and carefully sculpt it into the framework of a natural ear. Templates are created from the patient’s normal ear and used as a guide to mirror the shape and contours on the opposite side.
Microtia repair is more complex than cleft surgery and requires multiple surgeons working together during the first stage of reconstruction. In many operating rooms, three or four surgeons worked simultaneously to complete each procedure. Because enough rib cartilage must be present, most children are at least five or six years old before surgery can begin.
The reconstruction process typically requires at least two stages. Families in Antigua often had to return the following year to complete the next phase of surgery. Additional touch-up procedures for scars or contour refinements were common, and many children ultimately required three or more surgeries to achieve the final result.
Antigua itself is a beautiful historic city known for its colonial architecture, colorful buildings, and cobblestone streets. Working in a rainforest climate meant daily afternoon downpours were almost guaranteed. It was common for water to rise above ankle level during the walk home from the hospital, and Dr. Kolstad quickly learned to keep a pair of flip-flops ready for the journey back each evening.
