1/58. A near closed book contracture of the ear: a case report. An unusual post-burn ear contracture, involving crus helicis, cymba conchae, tragus and antihelix, with anterior vertical folding of the ear on itself, like a closed book, has been described. The contracture was completely released and the resultant raw area was covered by a full thickness skin graft, harvested from the opposite post-auricular area. The crippled ear cartilage was still folded anteriorly at the level of the concha, regardless of complete release, due to long standing childhood burns. Three months later, concha-mastoid suturing was carried out to give the ear its normal shape and erect, prominent position. Four years of follow up showed, an aesthetically good-looking ear with satisfactory position. ( info) |
2/58. Ear deformity in children following high ear-piercing: current practice, consent issues and legislation. In this presentation we examine the practice of high ear-piercing in children, the issue of informed consent and current legislation. We sampled current practice and consent policy by visiting nine establishments in Sheffield providing this service. There were two high street department stores, two fashion accessory outlets and five body-piercing studios. Enquiries were made as to the technique used, knowledge of complications, customer counselling and consent policy. A photograph of an ear with a cosmetic deformity following high ear-piercing was shown and awareness of this possible outcome was noted. Two ear-piercing techniques were identified, either a spring-loaded gun firing a blunt stud or the use of a body-piercing needle. The fashion accessory outlets were prepared to pierce any part of the ear using a spring-loaded gun in children under 16 years of age. There was a general lack of knowledge about possible serious complications. Two of the body piercers would not perform high ear-piercing on clients under the age of 16 years. The body piercers use a disposable needle and were of the opinion that using a spring-loaded gun shatters the cartilage and increases the risk of infection. The best technique is open to debate and it may be that the perceived unsavoury environment of the body-piercing studio represents a safer option than the more respectable or cheaper alternatives. The practice of body piercing in the UK remains uncontrolled. ( info) |
3/58. Total ear reconstruction in the devascularized temporoparietal region: I. Use of the contralateral temporoparietal fascial free flap. Total ear reconstruction by the use of contralateral temporoparietal fascial free flap and autogenous costal cartilage was performed in 16 patients presenting with a devascularized temporoparietal region resulting from trauma or prior surgery. The microsurgical success rate was 87.5 percent (14 of 16 transplants). On evaluation of the final aesthetic result in 11 patients followed up for more than 3 years, nine patients were graded good-to-excellent and two patients exhibited fair-to-poor results. Despite the relatively long operating hours and the comparatively low microsurgical success rate, ear reconstruction by autogenous tissue transplantation has proved to be an encouraging and worthwhile experience. This article presents the clinical cases and discusses the technical details. ( info) |
4/58. replantation of the severed ear. A successful replantation of a completely amputated ear segment using the modified subcutaneous pocket principle has been presented. This method overcomes most of the disadvantages of other reconstructive techniques. ( info) |
5/58. Redefinition of the helical rim in cauliflower-ear surgery. Cauliflower ear is a serious deformity of the auricle induced by single or repeated injury to the external ear. Few papers deal with surgical techniques for correcting this deformity. We describe the use of ipsilateral excess cartilage to restore the helical rim. ( info) |
6/58. Traumatic auricular hematoma: a case report. Traumatic recurrent auricular hematoma can be a challenging medical problem, with complications resulting in cauliflower ear. Proper management often depends on an understanding of the pathophysiology and pathogenesis of fibroneocartilage--an abnormal fibrous cartilage formation in response to injury. Traditional treatment by incision and drainage, and compression dressing technique may be inadequate in the setting of recurrent or chronic hematoma. Instead, excision of the fibroneocartilage is essential in promoting hematoma resolution and wound healing. Appropriate treatment of auricular hematoma can reduce needless cosmetic deformity and can avoid difficult secondary reconstruction. The authors present a case of recurrent auricular hematoma and review its pathophysiology and current therapy. ( info) |
7/58. Piercing the upper ear: a simple infection, a difficult reconstruction. Piercing the upper ear to retain jewellery is now commonplace. When infection ensues, devastating chondritis leads to collapse of the ear. To our knowledge, the surgical reconstruction of post-piercing deformities has not been documented in the literature. We present five such cases referred for autogenous-tissue ear reconstruction. In four of these, the destroyed segments of ear cartilage were replaced with a carved costal-cartilage framework. One patient declined surgery. The importance of preventing infection is stressed. ( info) |
8/58. Earlobe reconstruction with a reverse-flow chondrocutaneous flap. Many techniques have been described for earlobe reconstruction, but a stable and satisfactory shape has not always been obtained, mainly because of secondary retraction. A method of creating an earlobe using a reverse-flow postauricular chondrocutaneous flap combined with a cutaneous flap is presented. No skin graft is needed. The result was stable at 2 years follow-up. ( info) |
9/58. Reconstruction of congenital and acquired earlobe deformity. The appearance and symmetry of the auricle is crucial for the maintenance of facial cosmetic harmony. The earlobe is considered to be an important attribute of beauty in most cultures, and earlobe decoration with color or earring is a common practice in many societies. A reconstructive technique for congenital or acquired deformity of the earlobe is described. In addition, the postauricular chondrocutaneous flap is very convenient for reconstruction of various auricular parts. ( info) |
10/58. Surgical correction of cauliflower ear. We have classified the cauliflower ear into different types according to the zone and the degree of deformity. One major group is deformity without change in the outline of the ear, and this is divided into four subgroups according to the zone. All of these subgroups can be treated by shaving the deformed cartilage through suitable incision lines. For deformities accompanied by a skin deficit, a postauricular skin flap should be used. The other major group is deformity accompanied by a change in the outline of the ear, which is divided into two subgroups. If the ear is rigid, a conchal cartilage graft is used. If the structural integrity of the ear is poor, costal cartilage is used to provide rigidity. ( info) |