A New Technique to Preserve Ear Projection after Successful Non-Microvascular Ear Replantation: A Case Presentation
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- Category: Vol. 80, September 2012
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A New Technique to Preserve Ear Projection after Successful Non-Microvascular Ear Replantation: A Case Presentation,MAGED Sh. SALEH
Abstract
Objective: To present a new technique to preserve ear projection after successful non-microvascular ear replantation.
Case Report: A Saudi male aged 22 years had avulsion of his right ear. The cartilaginous skeleton was anatomically repaired as much as possible. Then, the cartilaginous skeleton was widely fenestrated. The postauricular skin on both the amputated ear and the head was excised and discarded; the ear was sutured to the remaining part and to the postauricular bed with a tie over as a composite graft. Three months later, the patient was readmitted for separation of the attached ear. A silicone implant was inserted under the attached ear by creating a pocket under the ear; which is slightly bigger than the replanted part, to allow for edge folding after removal of the implant. The implant was kept for almost 1.5 months. The patient was taken for the last time for removal of the implant and correction of the ear projection. An incision was made around the outer margin of the implant in a zigzag manner, to help in edge folding then the implant was removed. The outer layer of the formed fibrous capsule was partially excised and scored and the inner layer was folded over itself to produce projection of the ear. Full thickness skin graft taken from the right grown area was harvested and defatted and applied to both the postauricular and back of the separated ear with tie over. The first postoperative dressing was done one week after surgery and showed good graft take and projection. The patient was followed for 6 months after discharge in the outpatient clinic with accepted aesthetic results and projection, in spite of the marked disfiguring nature of the trauma to the ear.
Conclusion: The modification used in this case presenta-tion, though multi-staged, could be an alternative for both safe ear separation and correction of projection after successful replantation. Moreover, the folded capsule that caused projec-tion can make good cover for an implant over which skin graft can be laid safely if the projection caused by the capsule folding is not enough.