Vinoth Kumar, D (2008) Reconstruction of Acquired Pinna Defects. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: The pinna is both a functional and aesthetic appendage. The 3dimensional nature of the ear with its many curls, peaks and valleys makes this one of the most elegant body parts. The rigid structure of the cartilage along with its elastic nature is a testament to its unique properties, which make it very difficult to reproduce. Even minor deformities of pinna may cause psychosocial stigmatization. The lack of an ear, or part of it, is a significant deformity, and the psychological trauma should not be underestimated. In some, particularly teenagers, concern over a deformed ear lies at the root of serious behaviour problems. Lack of an ear is also a disability as the ear supports glasses, sunglasses, Bluetooth headsets and headphones. Reconstruction of the ear can be a complex process. Ear reconstruction can be traced back as far as eighth century India and the Susruta Samhita, a text of ancient medicine, which described the use of a cheek flap to repair an earlobe defect. Although auricular reconstruction has been performed for a long time, its technical complexity is still considered a challenge. Many recent innovations have made excellent reconstruction possible. The challenge of matching the flexibility of an ear while maintaining its rigidity and skin covering is the bane of reconstructive surgeons. AIM OF STUDY: 1. To evaluate various surgical procedures for acquired pinna defects and evaluate their aesthetic and functional outcome. 2. To select a treatment protocol based on the algorithmic approach to the problem for improving the outcome. MATERIALS AND METHODS: This study was conducted in the Department of Plastic Surgery, Government General Hospital and Madras Medical College during the period of September 2005 to April 2008. All patients who presented with acquired deformities of Pinna were included in this study. This includes patients who presented with pinna injuries following Road traffic accidents and chronic defects following trauma, burns, human bites, infections and tumours. Patients with large or torn ear lobule hole also were included. A total of 160 cases were included in this study. Pinna defects – 120 patients – 145 pinnas. Ear lobule repair – 40 patients – 75 ear lobules. All patients were assessed with a thorough history, clinical examination, pre operative planning. Routine investigations done for all patients preoperatively. In stable patients, primary repair of pinna injuries done on the same day itself. Patients with associated severe head injuries were excluded from the study. In some patients ,after Neurosurgeon's intervention, soft tissue repair done by Plastic Surgeons. Patients who presented with keloids in the pinna are excluded from the study. Informed consent obtained from all the patients. Patients with simple defects were operated in a single stage. Patients with composite defects of Pinna needed 2 or 3 stages of reconstruction, with an interval of 1 to 3 months in between each stage based on the type of reconstruction. Proper instructions were given to the patients in the initial stage of reconstruction itself. Follow up on 2nd week, 1st month and then at 2nd month for cases which needed reconstruction with cartilage grafts, flap covers. OBSERVATION & RESULTS 1. Total number of patients operated following RTA, burns, infection, tumour is 120 ( Ears 145). Side: Right ear 44, Left ear 51, Bilateral 25. Sex: Males 104, Females 16. 2. No. of cases operated for large earlobule hole is 40. (Earlobules 75). Side: Bilateral 35, Right ear lobule 4, Left ear lobule 1, All are female patients. ETIOLOGY: Etiology No. of patients; 1. Road traffic accidents 86 (71.6%), 2. Assault 26 ( 21.7%) (Human bite – 14) (Other reasons – 12). 3. Burns sequelae 3 (2.5%), 4. Infection sequelae 2 (1.7%), 5. Tumour (Benign) 3 (2.5%) (Naevus 2) (Pyogenic granuloma1). CONCLUSION: ● Ear reconstruction in acquired pinna defects needs proper preoperative planning, meticulous tissue handling and correct surgical techniques to achieve good results. ● In trauma, proper wound debridement and primary suturing in layers prevented multiple stages of reconstruction to reduce the morbidity to the patient. ● In Patients presenting with composite defects of Pinna, first stage of reconstruction is attempted on the day of injury, utilizing the cartilage of the damaged pinna if possible underneath the flap or banking it in a clean site. This reduces one stage of reconstruction later and also avoids the need for cartilage graft from other sites. ● Timely coverage of exposed cartilage framework of Pinna using skin grafts or with local flap cover prevented the deformities which may need multiple stages of reconstruction. ● In Burns , the damaged ears should be managed properly to prevent infection, dessication and loss .After scar maturation, reconstruction to be attempted in stages methodically. ● In Human bites, tetanus immunization, proper debridement with suturing of skin advised initially, followed by reconstruction at a later date. ● All techniques for Ear reconstruction in our series have produced aesthetically acceptable results. ● Strict road safety measures, wearing of helmets, banning drunken driving could decrease the incidence of Road traffic accidents thereby decreasing the main etiology of Pinna injuries.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Reconstruction ; Acquired ; Pinna Defects. |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:33 |
| Last Modified: | 12 Oct 2017 01:33 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3487 |
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