|Year : 2019 | Volume
| Issue : 1 | Page : 48-51
Reconstruction of lost ear lobule
Subodh Kumar Arige, Ramesh Pokkula, Avula Krishnaveni
Department of Burns and Plastic Surgery, Gandhi Medical College, Gandhi Hospital, Hyderabad, Telangana, India
|Date of Submission||17-Feb-2015|
|Date of Acceptance||29-Sep-2015|
|Date of Web Publication||26-Apr-2019|
Dr. Subodh Kumar Arige
13-6-457/29, Gayatrinagar, Shivbagh, Gudimalkapur, Hyderabad - 500 067, Telangana
Source of Support: None, Conflict of Interest: None
Introduction: An absent ear lobule may be congenital or the result of trauma, infection, etc. Many procedures have been described for reconstruction.
Aim: To present our experience with the Zenteno Alanis and the Gavello techniques.
Materials and Methods: The lobule was reconstructed in four patients. Reconstruction of the lobule in the first patient was done by Zenteno Alanis technique and in the next three patients, it was done by Gavello's technique.
Results: Results were satisfactory with both techniques. Division and inset were needed in Zenteno Alanis technique to correct the bunched skin behind the lobule at the base of the flap. The scar was inferior and visible. In Gavello's technique, the surgery was single-staged and the scar was retroauricular.
Conclusions: Zenteno Alanis technique needed “division and inset” and the scar was visible. Gavello's single-staged reconstruction resulted in a scar, which could be concealed.
Keywords: Base, bilobed flap, flap, length, lost ear lobule, reconstruction
|How to cite this article:|
Arige SK, Pokkula R, Krishnaveni A. Reconstruction of lost ear lobule. J NTR Univ Health Sci 2019;8:48-51
| Introduction|| |
Ear lobule may be absent from birth or may be lost as a result of trauma, infection, etc. The habit of wearing ornaments on the lobule, which is prevalent among females and has caught up with males makes it an important aesthetic unit. When lost, the reconstruction of the lobule is sought later. A lot of techniques have been described for reconstruction. Multistaged procedures are adopted if the neighboring tissues are scarred and single-staged procedures are attempted if the perilobular tissues are healthy.
To present our experience with the established Zenteno Alanis and the Gavello techniques.
| Materials and Methods|| |
The study was undertaken on four patients with lost ear lobules.
Zenteno Alanis technique was adopted for the first patient and in the next three patients, the Gavello's technique was adopted to reconstruct the ear lobule.
A female aged about 32 years had come for reconstruction of her lost right ear lobule. The reconstruction was undertaken by Zenteno Alanis technique. A template of the ear lobule was made from the unaffected ear lobule and the marking made on the lost side. Points “a”, “b,” and “c” are marked with the template made. Then point “d” is marked in a way that ca = cd [Figure 1]a. The flap is harvested by incising along c, d, b, and a [Figure 1]d. The edges are freshened on the ear with lost ear lobule. Inset is given [Figure 1]e. The donor wound is approximated [Figure 1]f. The base of the flap on the medial aspect showed bunching [Figure 1]g. Division and inset of the flap were performed after 3 weeks to address the retroauricular bunching of the flap [Figure 1]i-k]. The flap settled well. The scar inferior to the reconstructed lobule was in a visible portion.
|Figure 1: (a) Line diagram with markings (Zenteno Alanis technique) (b) Case 1 with defect (c) Marking (d) Flap harvest with freshening of scar edge (e) Flap inset on the defect (f) Flap inset and donor area closure (g) Flap bulge at the base after suture removal (h) Flapdivision and inset in Case 1 after 3 weeks (i) After flap division and inset (j) During suture removal (k) Retroauricular surface during suture removal after division and inset|
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Cases 2, 3, and 4
Gavello's technique was adopted for the next three patients. The design of the Gavello flap is as given below.
A. Schematic drawing [Figure 2]a.
|Figure 2: (a) Flap design and marking of Gavello's technique (b) Case 2 with defect (c) Marking (d) Flap harvest (e) Flap inset (f) Closure of donor wound (g) Healthy flap during suture removal (h) Retroauricular scar and flap|
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B. Preoperative marking [Figure 2]c.
A straight line (A-B) was drawn on the postauricular mastoid skin along the cut margin of the earlobe. This line was further extended posteriorly to point C such that AB = BC. A point D was marked approximately in a way that AB = BC= AD vertically below point A. From point D, a double-curved line (D-E-C) was drawn, joining points D and C. The bilobed flap thus formed was raised by subcutaneous dissection with caution to avoid injury to the posterior auricular artery, which runs at the base (A-D) of the flap. The cut margin of the earlobe was paired and freshened [Figure 2]d. The bilobed flap was folded on itself along B-E. AB and BC were sutured with the anterior and posterior paired margins of the earlobe, respectively. The lower curved borders of the bilobed flap were sutured with one another to form the free margin of the new earlobe [Figure 2]e. The donor site defect was closed primarily after wide undermining [Figure 2]f. The sutures were removed after 2 weeks.
| Results|| |
Ear lobules reconstructed by both the techniques, viz., Zenteno Alanis and Gavello were aesthetically appealing and resembled the normal lobule in curvature, color, and texture.
The first patient who underwent reconstruction by the Zenteno Alanis technique needed a second surgery in the form of division and inset of the flap after 3 weeks. The scar on the donor area of the flap was inferior to the reconstructed lobule.
In the reconstructions done by Gavello's technique, we harvested the flap with base-to-length ratio of 1:2. The three patients who had reconstruction by the Gavello's technique had no complications regarding the flap. The scar of the donor area was in the retroauricular region [Figure 3] and [Figure 4].
|Figure 3: (a) Case 3 with defect (b) Marking of Gavello's flap in Case 3 (c) Flap elevation (d) Flap inset and donor area closure (e) After suture removal|
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|Figure 4: (a) Case 4 with defect (b) Well-settled flap (c) Scar of the donor area of the flap with some hypertrophicit|
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| Discussion|| |
The earlobe is a small but aesthetically crucial structure. The challenge in earlobe reconstruction surgery is to obtain a natural-appearing structure with a durable outcome. The technique should be simple, preferably performed in one stage, suitable for earlobe defects of all sizes and volumes, and yield acceptable cosmetic results.
A variety of single-stage and two-stage reconstructive techniques have been described for earlobe reconstruction. These techniques mainly use local skin flaps from the preauricular, infraauricular, retroauricular,, and retromandibular areas or the auricular surface depending on the flap design. Doubled-over single or bilobed flaps and superimposition of two opposing or paired flaps or double-crossed flaps may be used; some techniques require a split-thickness skin graft or full-thickness skin graft in addition to the flap. Some of the procedures involve the incorporation of a cartilage graft into the reconstructed earlobe to maintain shape.
The advantages of the Zenteno Alanis technique are as follows: It is a simple, one-stage procedure; it is suitable for both immediate and delayed reconstructions; it relies entirely on the local tissue for reconstruction; skin grafting is not required; it yields excellent cosmetic results with the preservation of earlobe shape and volume; it provides excellent color match; and the procedure can be used for large defects or even total loss of earlobe. The limitation of the procedure is the need for a second surgery in the form of “division and inset” to bring about better aesthetics on the reconstructed ear lobule on the medial aspect. The resultant scar of the donor area in a visible area and is difficult to conceal. The advantages of the Gavello's technique are that the flap has a predictable vascular supply. Occipital branch of the posterior auricular artery that runs horizontally behind the ear is a constant vessel in the area where Gavello's flap is raised, which allows the flap dimensions of base-to-length ratio of up to 1:2 to be raised without any complication. The donor site scar is well-concealed as shown in the three patients of the present series. The limitation of the procedure is the requirement of an intact donor area over the postauricular mastoid region.
| Conclusion|| |
In the present article, the reconstructions were based on Zenteno Alanis technique and Gavello's technique. Excellent results have been achieved. Flap with base-to-length ratio of 1:1 in Zenteno Alanis and up to 1:2 were raised in Gavello's technique without any complications of the flap. Gavello's technique is a single-staged reconstruction and the scar could be concealed while in Zenteno Alanis technique, bunched skin on the medial aspect of the ear lobule needed a second surgery, and the scar of the donor area was visible and was not easy to conceal. Thus, it can be concluded that such “old,” simple flaps are still of great value. The need is therefore, for either split-thickness graft or full-thickness graft by which the scar at the donor site of the graft can be avoided.,
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]