|Year : 2013 | Volume
| Issue : 1 | Page : 73-75
Ear lobule reconstruction using post-burn scarred skin tissue flap
Sudhir S Karmarkar
Consultant Plastic Surgeon, Karmarkar Hospital, Nashik, Maharashtra, India
|Date of Web Publication||22-Nov-2013|
Sudhir S Karmarkar
Consultant Plastic Surgeon, Karmarkar Hospital, 7, Rohini Ravi Apartment, Canada Corner Sharanpur Road, Nashik - 422 002, Maharashtra
Source of Support: None, Conflict of Interest: None
During a neck contracture reconstructive surgery, author successfully implemented earlobe reconstruction with a post-burn scarred skin tissue flap. Since this flap is difficult it is generally avoided. But in this case author obtained consent with risk, prior to the surgery. Design was similar to the flap described by Zenteno. Flap base was broad and during the operation, there was good bleeding at the distal end of the flap probably due to supple nature of the mature burnt skin, its proximity to ear, neck and face region and good blood supply. Post-operative result after 6 weeks revealed an aesthetically pleasant neck, proportionate, soft, aesthetic, sensate ear lobule with ability to wear earrings of her choice.Ear lobule reconstruction was achieved using post-burn scarred skin tissue flap safely. Author recommends its use for its advantage of good aesthetic and sensate lobule so achieved.
Keywords: Ear reconstruction, earlobe reconstruction, local flap, pinna deformity, post burn scar flap, use of post burn scarred skin tissue flap
|How to cite this article:|
Karmarkar SS. Ear lobule reconstruction using post-burn scarred skin tissue flap. Indian J Burns 2013;21:73-5
| Introduction|| |
Though in case of face and neck burns, ear reconstruction generally takes last priority; but in this case, patient being a female of marriageable age, it was one of her first priorities. Author presents a successful reconstruction of the ear lobule using post-burn scarred skin flap during an operation of release of neck contracture and skin grafting.
| Case Report|| |
An 18-years-female with a nine-month-old alleged history of suicidal facial flame burns presented with medium dermal depth, mature, supple post-burn scars surrounding the right ear and on the chin, cheek, neck, and supple neck contracture. She had no definition of the ear lobule [Figure 1]a and b and was keen to have an early aesthetic restoration of neck and a lobule to wear an ornament. Author decided to use the one-stage Zenteno method,  with essentially two modifications [Figure 2]; first, the use of post-burn scarred skin (instead of normal skin) for the flap and secondly coverage of flap donor site with split skin graft (instead of its primary closure). A template of her normal left ear lobule was used for determining the size and shape of the flap. A flap larger than the template (3mm extra at the base and 5mm extra elsewhere) was elevated gently. Two mm of doubtful edge of the flap was trimmed at the business end of the flap (i.e. superior, medial, and lateral edges of the flap) without reducing the breadth of the flap after which, there was satisfactory bleeding at all the cut ends. Remaining 3mm extra at base and borders of flap, were kept deliberately to compensate for the natural tendency of flap tissue contraction. The remaining neck scars were excised and the neck contracture was released. The flap was folded and inset to recreate the ear lobule. Raw surfaces of flap donor area and the neck were covered with split skin grafts. The post-operative period was uneventful. Post-operatively a soft neck collar splint was given. Post-operative result after 6 weeks revealed an aesthetically pleasant neck as well as a proportionate, soft, aesthetic, and sensate ear lobule with ability to wear earrings of her choice [Figure 3]a-c.
|Figure 3: (a) Ear lobule-post-op front view, (b) ear lobule-post-op lateral view, (c) ear lobule-wearing earring front view and lateral view|
Click here to view
| Discussion|| |
Ear lobule loss can be due to varied etiologies and the skin surrounding the ear lobule may be normal or scarred. In the current case, skin surrounding the ear was scarred. Besides achieving an aesthetic look, an important requisite of ear reconstruction is to provide adequate sensation especially for those who desire to wear pendant earrings, since a de-sensate lobule would be more vulnerable to traumas causing laceration. The author executed Zenteno's one-stage method with modifications, using post-burn scarred skin tissue flap. The reconstructed lobule was proportionate (ear length equal to opposite ear), soft, aesthetic, and sensate with ability to wear earrings.
During review of literature, author found reports of one stage reconstruction of ear lobule  using flaps of normal skin around the ear and of flaps using scarred skin  for reconstruction other than ear lobule. Author did not find any report of one-stage ear lobule reconstruction using post-burned scarred skin tissue flap. Flaps using scarred base or skin are generally avoided due to their paucity of blood supply and elasticity. But it was used in this case because of the mature, supple nature of the post-burn scars. Hence contributing factors behind the successful survival of the flap could be as follows:
- The unscarred broad base of the flap in continuity with normal skin of ear
- The supple and mature nature of the post-burn scar
- Regional specialty of the skin donor site namely ear, cheek, face, and neck of having rich blood supply.
- Burn depth: Superficial to Medium deep dermal depth burn, in this case.
Hiko Hyakusoku  in his extensive work has reported successful use of scarred flap tissue. He mentions the importance of burn depth, appropriate design, and careful preoperative assessment of scars. He also mentions use of Doppler, Color Doppler, Multidetector Computed Tomography (MD-CT) and intra-operative assessment of bleeding from cut edges as tools to access thickness and suppleness of flap for the successful survival of a scarred flap. Since this was not a large flap, Doppler, Color Doppler, and MD-CT were not done and the author relied on clinical observations and judgment.
| Conclusion|| |
Author feels that this method is safe and useful if the above points are adhered to and recommends its use for the advantage of an aesthetic and sensate ear lobule reconstruction achieved with it.
| References|| |
|1.||Alanis SZ. A new method for earlobe reconstruction. Plast Reconstr Surg 1970;45:254-7. |
|2.||Converse JM. Reconstruction of auricle. Plast Reconstr Surg Transplant Bull 1958;22:150-63. |
|3.||Yongwei P, Jianing W, Junhui Z, Guanglei T, Wen T, Chun L. The abdominal flap using scarred skin in the treatment of post burn hand deformities of severe burn patients. J Hand Surg Am 2004;29:209-15. |
|4.||Hiko Hyakusoku. Scarred Flap. Chapter 36. In: Hyakusoku H, Orgill DP, Teot L, Pribaz JJ, Ogawa R, editors. Color Atlas of Burn Reconstructive Surgery. 1 st ed. Part 6. Berlin, Heidelberg: Springer; 2010. p. 320. |
[Figure 1], [Figure 2], [Figure 3]