Study of Reconstruction of Acquired Auricular Defects

INTRODUCTION: The human ear is a paradox. Conceptually simple it is a sandwitch, skin cartilage and skin, but in construct infinitely complex. Reconstruction of human ear is one of the greatest technical and aesthetic challenges, facing the plastic, reconstructive and aesthetic surgeon. The structure of ear has no ethnic or racial variation. The three dimensional nature of the ear with many curls, peaks, and valleys makes this one of the most elegant body parts. The rigid nature of cartilage along with its elastic nature is a testament to its unique properties which makes it very difficult to reproduce. Even minor deformities of pinna causes psychological distress. Some develop serious, behaviour problems and mood swings. Functional loss of pinna is a disability as ear supports glasses, head phones, bluetooth head sets. Reconstruction of the ear can be a complex process. In certain cases staged reconstruction may be needed. Though reconstruction can be traced back to era of eighth century B.C. as recorded in Sushruta Samhita now even after advent of autologous tissue, alloplastic material, tissue engineering, tissue expansion, prelaminated free flaps, ear reconstruction has been a great challenge. It is difficult to match the flexibility of the ear while maintaining the rigidity and skin covering. AIM OF THE STUDY: 1.To assess the various causes of acquired pinna defects. 2. To study the age, sex distribution of the patients 3. To evaluate results, outcome of various surgical procedures. 4. To study the complications of various procedures. 5. To evaluate the advantages of primary reconstruction over secondary reconstruction. MATERIALS AND METHOD: The study was conducted in the department of plastic surgery. Government Rajaji Hospital, Madurai Medical College, Madurai during August 2007 to April 2010. Patients with acquired auricular defects were included in the study. Patients with no tissue loss and managed by primary suturing were not included in this study. All patients included with acquired defects were due to road traffic accident, assault, human and animal bites, burns, infection and tumour. A total number of 43 cases were included in the study. All patients were assessed with a thorough history, clinical examination investigations and preoperative planning. In stable patients primary single staged repair was done or first stage of the staged reconstruction was done on the day of trauma. In patients with associated injuries they were taken up after proper resuscitation. Pattern and template were made are per tissue loss. Procedures outcomes, complications were explained to the patients and informed written consent were obtained for all patients. Cases were followed up after 1 week, and 2 weeks then monthly for atleast 3 months after the final stage of reconstruction. CONCLUSION: • Timely coverage of cartilage framework using local flaps prevented perichondritis and deformities. • For upper third defects superiorly based post auricular flap were ideal. • For middle third defects Converse tunnel, Diffenbach and bipedicle flaps were done either with or without cartilage graft. • Double cross skin flap gave good aesthetic results and was very much useful in primary reconstruction of ear lobule in single stage. • When lobule with helical defect was present staged reconstruction with inferiorly based post auricular flap were ideal. • For near total loss and scarred skin in adjacent areas as in burns cartilage graft with temperoparietal fascial flap with skin graft were ideal. • Road traffic accidents were mainly following alcohol intake and driving without helmet. Road safety measures like wearing of helmet and banning drunken driving could decrease the incidence of road traffic accidents. • Burns injury of ear should be taken care at initial phases itself to prevent earlier complications and late deformities. • Ear is a major focus for bite injuries. It is difficult how aggression could be managed. Proper education and improving the livelihood, avoiding alcohol intake prevents quarrels and assaults thereby decreasing the incidence of ear injuries. • Even in human bites and road traffic accidents, proper wound debridement antibiotic coverage, primary repair or first stage of the staged reconstruction could be done. • It is ideal to reconstruct the pinna defects primarily so that patient were pleased and their self confidence were greatly boosted. • Prevention is better than cure