Ear Reconstruction Flashcards
Describe the etiology of cauliflower ear
- auricular hematoma - hematoma forms deep to perichondrium - forms clot then forms new catilage which curls and deforms - acute - drain hematoma and bolster - late - >10days, excise fibroneocartilage layer anterior to true cartilage and bolster
Describe your management of a thermal injury to an ear
Prevent Chondroitis suppurativa - with sulfamylon onver eschar- - keep eschar as biologic dressing - if suppurative, debride and temporary STSG as biologic dressing - Abx cephalosporin + ciprofloxacin
Describe your management options for ear keloid
- excision - intralesion steroid injection - pressure - any of the above in addition to excision - Excision plus radiation (lowest recurrence rate if commenced
DDx for benign skin lesions of an ear
- keloid - chondritis nodularis chronica helicis (excise cartilage, not skin) - actinic keratosis - vascular lesion
DDX for malignant skin lesions of an ear
BCC, SCC KA Melanoma Meckel cell
Describe the sensation to the ear
Greater auricular n (C2,3) - lobule and inferior 1/2 of auricle ATN (CN5) - root of helix and tragus Lesser occipital (C1,2) - superior posterior auricle CN X Arnolds - concha and posterior EAC CN 9 Jacobson - anterior EAC
What are your goals of reconstruction for acquired ear defect
- correct size, orientation and position - support fo eyeglasses - patent EAC
What are the subunits of the ear
Helical rim - key for aesthetics Lobule- key for aesthetics Antitragus Antihelix - if abnormal leads to protrusion/cauliflower deformity Concha - dispensable Cavum conchae
What are your goals of reconstruction for acquired ear defect
- correct size, orientation and position - support fo eyeglasses - patent EAC
Describe your appraoch to auricle defect recon by location
- Helical rim
- Antia Buch
- Pedicled/local skin flap and cartilage graft
- Upper 1/3
- Antia Buch
- Conchal Chondrocutaneous rotation flap (orticochea)
- Banner flap and cartilage graft
- preauricular skin flap and cartilage graft
- Middle 1/3
- Antia buch
- 1’ closur with wedges and accessory triangles/crescents (Tanzer)
- Converse Tunnel procedure - post-auricular tubed flap
- Dieffenbach
What are recontructive options for acquired ear defect
1’ closure with wedge FTSG/STSG Local flaps: Antia buch, Tunnel procedure, Converse flap, Pocket principle??, banner flap, retroauricular skin flap Composite grafts Regional flap: TPF Microvascular replant prosthesis with osseointergated implant
Describe the orticochea flp
Conchal chondrocutaneous pedicled flap based on crus of helix - to reconstruct upper and middle 1/3 deefects - concha is incised and rotated except for pedicle along helix of 1cm width
Describe the dieffenbach flap
post-auricular advancement skin flap to cover the anterior defect and left pedicled at base. 2-3wks later, divide pedicle, inset posteriorly and graft defect
Describe the converse tunnel procedure
2stage postauricular skin use for recon without disruption of posterior auricular sulcus. - incise in postauricualr skin at level of defect - create tunnel under postauricular skin flap for inset of ear with attached cartilage graft - allow to heal 2-3mths - division and stsg defect
Describe the tanzer wedge/crescentric/triangle closure
1’ closure with wedges removed to prevent cupping
Describe the dieffenbach flap
post-autirucular advancement skin flap to cover the anterior defect and left pedicled at base. 2-3wks later, divide pedicle, inset posteriorly and graft defect
Describe the converse tunnel procedure
2stage postauricular skin use for recon without disruption of posterior auricular sulcus. - incise in postauricualr skin at level of defect - create tunnel under postauricular skin flap for inset of ear with attached cartilage graft - allow to heal 2-3mths - division and stsg defect
Describe the tanzer wedge/crescentric/triangle closreu
1’ closure with wedges removed to prevent cupping
What is your managment of a sharp ear amputation?
replant is possible using branch of STA/V
WHat are your thoughts on banking cartilage
hyaline cartilage will warp and scar - not good for banking. Composite graft is possible if in child or small
What are options for total ear reconstruction
Non-op - prosthesis Op - skin coverage and framework needed = TPF, RFFF = synthetic or autologous framework - prefabricated RFFF
What are synthetic materials for ear prothesis
medpore, hydroxyapetite
What are complications of ear reconstruction
Infection - chondritis - suppurative chondritis - IandD, chondrectomy, cipro and penicillin/cephalo for pseudomonas and staph Keloids
What is your managment of the burned ear
- leave eschar as biologic dressing - sulfamylon to penetrate eschar (antipseudomonal activity) - release scar contractures w zplasty and keep EAC open w stent
What is the pocket principle
dermabrasion of auricular catilage and buried under postauricular pocket. left for 3wks and once release will re-epithelialize
Describe the antia buch flap
For reconstruction of upper and middle 1/3 defect <2cm
- chondrocutaneous pedicled rotation advancement flap based on the posterior auricular skin
- incise along antihelical sulcus and dissect postauricular skin off cartilage
- two tricks to prevent constricted ear: resect some of scapha to decrease perimeter size and advance root of helix
