Abstract
Multiple techniques exist for the repair of partial earlobe deformities. The procedures in use vary from minimal interventions involving marginal excision and closure, to cartilage grafting to prevent recurrence. A prospective study was conducted of 24 partial earlobe deformity repair procedures using the technique devised by the authors, involving a rotation flap for reduction of the defect size. Aesthetic outcomes and postoperative complications were assessed on the basis of clinical findings and photographic documentation. Sixteen female patients underwent the procedure of rotation flap repair of partial earlobe deformities (24 earlobes) between July 2011 and August 2012. The average age of the patients was 44 years, and the average length of follow-up was 14 months. Patient satisfaction was good. Adequate functional and cosmetic results were achieved in the first 2 weeks for 19 earlobes (79%). Good results were seen during 1 year of follow-up. The rotation flap technique appears to offer an effective method for partial earlobe defect repair, and thus provides another option for the management of partial earlobe defects.
Earlobe piercing is a universal trend, and in certain parts of the world is associated with various societal and cultural customs. In many countries of the Southeast Asian region, these piercings are a cultural requirement for females, however an increasing trend has also been seen for male ear piercings.
Earlobe deformities in those with pierced ears may result from the wearing of long or heavy earrings, or more rarely from an acute trauma, which may cause a complete clefting or deformity in which the margins are discontinuous.
Various studies have been published regarding the management of the completely or partially torn earlobe, reporting techniques that vary from simple suturing of the deformity (which was first performed by McLaren in the middle of the last century), to the more elaborate repair technique using a free conchal cartilage sandwich graft.
In this article, we describe the rotation flap lobuloplasty technique and review the results of 24 consecutive patients who underwent the procedure with an average follow-up of 14 months. The technique described would be useful in situations of partial earlobe deformity of a moderate to severe extent. The earlobe margins are not involved and re-piercing is not required as the original piercing tract is maintained.
Patients and methods
Patient selection
A total of 16 consecutive patients (all women) underwent the rotation flap lobuloplasty performed by one of two surgeons (SK and RS) between July 2011 and August 2012. The 16 patients (eight bilateral, eight unilateral) underwent preoperative evaluation by the operating surgeon. Patients were selected for inclusion if they had an acquired split earlobe deformity of type I or II, i.e. partially torn or incompletely split in nature. A type I deformity refers to an earlobe hole that is stretched to more than twice its original diameter; a type II deformity is the near total split of the earlobe with a thin rim of soft tissue remaining. Congenital deformities were not considered for repair using this technique.
Photographs were taken and simultaneous measurements were done of the defect at rest, without stretching the earlobe, using a Vernier calliper ( Fig. 1 ); this calliper is commonly used for measurements during cleft lip repair. In all cases, measurements were taken immediately preoperative, immediately postoperative, at the time of suture removal, and at 1, 2, 6, and 12 months postoperative. Aesthetic outcomes and postoperative complications were assessed with the aid of clinical findings and photographic documentation.
Technique
All cases were treated under local anaesthesia; a greater auricular nerve block was given. The use of standard magnifying surgical loupes (ErgonoptiX, the Netherlands; 2.5× magnification) was essential for precise visualization, which is critical in raising the flap for this technique.
All repairs were done as described by Sharma et al. : the extent of the triangular flap is marked ( Fig. 2 ); the full thickness triangular flap is raised from the posterior margin of the defect of the lateral surface ( Fig. 3 ); once the flap is raised, the remaining marginal epithelium of the rest of the defect is excised up to the superior margin of the defect, to the point where the insertion of the triangular flap is proposed ( Fig. 3 ).
The triangular flap is rotated onto itself in an anterosuperior direction to reach the intact marginal epithelium superiorly; this creates a circular epithelialized tract (<1 mm in diameter), which is the required result ( Fig. 4 ). If the tract diameter is larger than required, then a portion of the triangular flap is excised from its apex onwards to achieve the desired result.
The tip of the triangular flap is initially stabilized at the required position and then sutured, preferably using a 6–0 nylon material (Ethilon; Ethicon, India). Once the tract is created, the rest of the defect can be closed by primary closure, with none to minimal undermining both lateral and medial to the earlobe ( Fig. 5 ).
In all cases, a 1–0 silk suture was passed through the tract created to help maintain patency, and more importantly to identify the location of the tract during suture removal; this suture was removed along with the others on postoperative day 7–10.
Postoperative instructions
A small pressure dressing was applied over the earlobe, which was removed after 48 h, following which the patient was asked to keep the area clean by gently scrubbing with clean water and sterile cotton. The patients were instructed not to sleep on the side on which the procedure had been performed. Hence the procedure was done in a staged manner for patients who had bilateral presentation of the acquired clefting; the second procedure was performed after a 2-week interval.
Statistical analysis
Data were recorded as the mean ± standard deviation (SD). The statistical analysis was performed using IBM SPSS Statistics for Windows version 20.0 software (IBM Corp., Armonk, NY, USA). Repeated measures analysis was carried out to compare the significance of differences between measurements; P < 0.05 was considered significant.
Results
A total of 16 patients, 24 earlobes, were treated for partial ear deformities over a period of 1 year. These deformities varied from moderate to severe in nature. Of these patients with partial lobe deformities, eight cases were bilateral presentations (16 sides) for whom the repair was conducted in a staged fashion. The larger defect was repaired first (usually being the patient’s primary complaint) and the second earlobe was treated after satisfactory healing of the previously operated side. This was evidenced by the measurements of mesiodistal and superior–inferior dimension at rest. The dimensions were found to be high preoperatively and were significantly reduced postoperatively; they remained significantly reduced up to the last postoperative follow-up ( Table 1 ).
| Dimensions | Mean | SD | SE | 95% CI | P -value a | |
|---|---|---|---|---|---|---|
| Lower | Upper | |||||
| Mesiodistal dimension at rest (mm) | ||||||
| Preoperative | 1.917 | 0.654 | 0.133 | 1.641 | 2.193 | <0.001 |
| 1 month | 0.792 | 0.2518 | 0.051 | 0.685 | 0.898 | |
| 2 months | 0.792 | 0.2518 | 0.051 | 0.685 | 0.898 | |
| 6 months | 0.792 | 0.2518 | 0.051 | 0.685 | 0.898 | |
| 12 months | 1.000 | 0 | 0.000 | 1.000 | 1.000 | |
| Superior–inferior dimension at rest (mm) | ||||||
| Preoperative | 5.250 | 1.189 | 0.243 | 4.748 | 5.752 | <0.001 |
| 1 month | 0.792 | 0.2518 | 0.051 | 0.685 | 0.898 | |
| 2 months | 0.792 | 0.2518 | 0.051 | 0.685 | 0.898 | |
| 6 months | 0.792 | 0.2518 | 0.051 | 0.685 | 0.898 | |
| 12 months | 1.000 | 0 | 0.000 | 1.000 | 1.000 | |
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