Page 50 - Read Online

and antihelix, a wedge or star‑shaped excision technique is
a preferable option. It consists of a full‑thickness excision
[5]
of skin and cartilage with the apex pointing to the anterior
surface of the ear and extending to the conchal area. When
designing the wedge, it is important to define an apex
angle smaller than 30°. The resulting wound is then closed
[6]
primarily in layers, with the cartilage secured by long lasting
sutures. It is helpful, when possible, to use an offset skin
[5]
closure around the rim. To decrease the risk of rim notching,
the skin should not be approximated and secured over the
cartilage space. Usually, the ear is shortened slightly while
[7]
maintaining the premorbid contour. The advantages of
[7]
wedge resection are: a one‑stage operation, simple and fast
dissection, and minimal resultant scar.
However, the limitation of this technique is that it can
Figure 1: Ear laceration on helix extending anteriorly
be applied only for small defects of the helical rim and
neighboring structures. The wedge should be located in
the superior or posterior third to avoid deformity of the
ear. If the defect is larger or located near the anterior
helix, wedge resection cannot be used without severe
deformity of the ear. [2]
Our technique is quite similar to the one described
[9]
[8]
by Ferri and Schonauer et al., in terms of excising a
wedge triangle but lacks the second incision at the helical
root level. Aesthetic results of the reconstructed ear are
maximized by balancing forces on the frontal and sagittal
planes. Furthermore, anatomical landmarks and relative
a b
proportions are preserved.
Figure 2: Stitching with prolene 5‑0. (a) During stitching, (b) after stitching
This report shows that good cosmetic results can be
obtained by managing the ear avulsion with standard
procedure of wedge resection followed by primary repair.

REFERENCES

1. Havlik RJ, Sadove AM. Repositioning the malpositioned ear. Oper Tech Plast
Reconstr Surg 1997;4:141‑5.
a b 2. Elsahy NI. Reconstruction of the ear after skin and cartilage loss. Clin Plast
Surg 2002;29:201‑12, vi.
3. Reddy LV, Zide MF. Reconstruction of skin cancer defects of the auricle. J Oral
Maxillofac Surg 2004;62:1457‑71.
4. Elsahy NI. Acquired ear defects. Clin Plast Surg 2002;29:175‑86, v‑vi.
5. Park SS, Hood RJ. Auricular reconstruction. Otolaryngol Clin North Am
2001;34:713‑38, v‑vi.
6. Pham TV, Early SV, Park SS. Surgery of the auricle. Facial Plast Surg
2003;19:53‑74.
c 7. Calhoun KH, Chase SP. Reconstruction of the auricle. Facial Plast Surg Clin
North Am 2005;13:231‑41, vi.
Figure 3: Postoperative follow‑up. (a) At day 7, (b) lateral view, (c) 8. Ferri M. Treatment of partial losses of the helix. Plast Reconstr Surg
posterior view 1998;101:2011‑2.
9. Schonauer F, Campa D, Monaco A, Molea G. Staggered wedge technique for
Primary repair of the ear after wedge resection is a standard ear reconstruction. Plast Reconstr Surg 2010;125:e203‑4.
procedure followed for auricle injuries. When the helical
rim is affected, a vertical mattress suture should be placed How to cite this article: Singla B, Chawla I, Gautam P, Goyal A,
initially at the rim to evert the wound edges and level the Rathi J. Primary repair of ear laceration with wedge resection. Plast
Aesthet Res 2015;2:38-9.
wound. It is also important to stress the important role of
[4]
dressing and good wound care in order to obtain a better Source of Support: Nil, Conflict of Interest: None declared.
cosmetic outcome. [1,5] For small composite defects of helix Received: 21-05-2014; Accepted: 10-10-2014

Plast Aesthet Res || Vol 2 || Issue 1 || Jan 15, 2015 39