2017 has been a year full of ears for me! Five major ear reconstruction were undertaken in this period. Four of which i am sharing here, with due consent of patients. Just for the reader’s amusement and also of course for educative purpose.
Number 1 was an old dog-bite case. The second guy was attacked by decoits. 3rd was the congenital anotia. And the last had part of his ear cartilage dissolved by an abscess following ear piercing!
1. The loss of partial yet significant quantity of pinna needed a fairly large cartilage frame. Costal cartilage was carved into upper auricular frame and was buried under the mastoid skin. Later, the frame was elevated and the post-aural sulcus lined by a flap+skin graft. Caught this boy several weeks later with edema receding and the craftsmanship beginning to display itself. integrating the neo-cartilage with the remaining was a challenge. He will look better with some more touch-ups and laser ablation of hair. Hope he returns for the same. Another not-so-rare instance when the patient is more than satisfied; while the doctor isn’t yet!!
2. One unfortunate evening, assailant attacked this simpleton and chopped his pinna clean. Unlike an avulsed scalp, pinna cannot be re-implanted as it doesn’t have sizeable vessels. Hence, the cartilage frame was denuded taking care to strip every bit of skin away. It was then buried under the skin pocket. Unlike the frames carved in the harder costal cartilage, the thin native pinna cartilage lost much of the finer curvatures under the tight mastoid skin. Contrary to my expectation it looked less natural than the artificial pinnas i make from costal cartilages! Moreover it even began melting! I had to hurry for the second stage and elevated it earlier than we usually wait. Despite being flatter, it is of perfectly normal size and at perfect location. He shall pass off in social circles without being noticed. Some beer is better than no beer!!
3. “..of course there are potential complications in every procedure. Even God is not perfect- look at these kids..” is how I counsel my patients these days. Apparently the almighty forgot making this kids ear. “Devine negligence”?
An entire pinna framework was carved out of the largest single piece-the synchondrotic region of 6th and 7th costal cartilage plus the 8th. He now has a near natural ear pinna stuck to his head. He shall come for its elevation and lobule creation. remaining cartilage pieces are stored under the scalp to provide leverage in the next stage.
Case 4. Ear-piercing to cure Asthma! Anyone? This idiot now needs a major surgery to replace his pinna cartilage dissolved into pus; and he is ASA Grade III. (Asthma, you remember?). Easier to carve the pinna as his contralateral pinna is just plain too (shallow antihelix and scapha).
These ears will further get better after the edema completely subsides and skin shrinks and sticks to the cartilage. Hope to get long term follow ups. Yet, the results aren’t anyway close to the best results by Brent or Nagata- the stalwart ear-manufacturing surgeons. Nevertheless, the variety, the stories behind each case and the joy of reconstructing each of them is was fascinating. Hence wanted to share with you all- just for FUN.😊