Ear Reconstruction

Question 1

Describe the etiology of cauliflower ear

Answer 1

• 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

Question 2

Describe your management of a thermal injury to an ear

Answer 2

Prevent Chondroitis suppurativa - with sulfamylon onver eschar- - keep eschar as biologic dressing - if suppurative, debride and temporary STSG as biologic dressing - Abx cephalosporin + ciprofloxacin

Question 3

Describe your management options for ear keloid

Answer 3

• excision - intralesion steroid injection - pressure - any of the above in addition to excision - Excision plus radiation (lowest recurrence rate if commenced

Question 4

DDx for benign skin lesions of an ear

Answer 4

• keloid - chondritis nodularis chronica helicis (excise cartilage, not skin) - actinic keratosis - vascular lesion

Question 5

DDX for malignant skin lesions of an ear

Answer 5

BCC, SCC KA Melanoma Meckel cell

Question 6

Describe the sensation to the ear

Answer 6

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

Question 7

What are your goals of reconstruction for acquired ear defect

Answer 7

• correct size, orientation and position - support fo eyeglasses - patent EAC

Question 8

What are the subunits of the ear

Answer 8

Helical rim - key for aesthetics Lobule- key for aesthetics Antitragus Antihelix - if abnormal leads to protrusion/cauliflower deformity Concha - dispensable Cavum conchae

Question 9

What are your goals of reconstruction for acquired ear defect

Answer 9

• correct size, orientation and position - support fo eyeglasses - patent EAC

Question 10

Describe your appraoch to auricle defect recon by location

Answer 10

• 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

Question 11

What are recontructive options for acquired ear defect

Answer 11

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

Question 12

Describe the orticochea flp

Answer 12

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

Question 13

Describe the dieffenbach flap

Answer 13

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

Question 14

Describe the converse tunnel procedure

Answer 14

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

Question 15

Describe the tanzer wedge/crescentric/triangle closure

Answer 15

1’ closure with wedges removed to prevent cupping

Question 16

Describe the dieffenbach flap

Answer 16

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

Question 17

Describe the converse tunnel procedure

Answer 17

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

Question 18

Describe the tanzer wedge/crescentric/triangle closreu

Answer 18

1’ closure with wedges removed to prevent cupping

Question 19

What is your managment of a sharp ear amputation?

Answer 19

replant is possible using branch of STA/V

Question 20

WHat are your thoughts on banking cartilage

Answer 20

hyaline cartilage will warp and scar - not good for banking. Composite graft is possible if in child or small

Question 21

What are options for total ear reconstruction

Answer 21

Non-op - prosthesis Op - skin coverage and framework needed = TPF, RFFF = synthetic or autologous framework - prefabricated RFFF

Question 22

What are synthetic materials for ear prothesis

Answer 22

medpore, hydroxyapetite

Question 23

What are complications of ear reconstruction

Answer 23

Infection - chondritis - suppurative chondritis - IandD, chondrectomy, cipro and penicillin/cephalo for pseudomonas and staph Keloids

Question 24

What is your managment of the burned ear

Answer 24

• leave eschar as biologic dressing - sulfamylon to penetrate eschar (antipseudomonal activity) - release scar contractures w zplasty and keep EAC open w stent

Question 25

What is the pocket principle

Answer 25

dermabrasion of auricular catilage and buried under postauricular pocket. left for 3wks and once release will re-epithelialize

Question 26

Describe the antia buch flap

Answer 26

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