Secondary Reconstruction of the Ear

Abstract

Undoubtedly, reconstruction of the pinna is much more a matter of esthetic surgery due to the great importance of the organ concerning the balance of the face. Reconstruction of the auricle after traumatic amputation is more difficult since the skin covering the mastoid area is not ideal, but it is the best due to its location on the future auricle. However, performing secondary reconstruction is even more difficult because of surgical cutaneous scars resulting from previous operations. Prior to the secondary operation, the surgeon may consider the psychological aspects of the suffering of patients and their relatives due to unpleasant surgical results. I usually say that reconstruction of the auricle is a challenge that needs something more than just being a well-trained surgeon. To repair any ear deformity requires a lot of attention when planning, before surgery, as well as during the operation, and much care in the postoperative period to avoid any unexpected complications. However, if complications do occur, the proper treatment must be given as soon as possible in order to preserve the good relationship between the patient and the surgeon, which is very important.

The presence of scars represents a very difficult situation during reintervention, and post-operatively even more so. Besides these difficulties, there is another serious problem concerning the vascularization of the new auricular framework: it needs an excellent bed to provide adequate nutrition for the cartilage.

Before performing a secondary operation, the surgeon must properly evaluate several aspects of the patient to analyze the following: date of the last surgery; kind of framework material that was used; cutaneous scars; the presence of remnant cartilage from the congenital ear dysgenesis or due to previous surgery with a cartilage graft; quality of the skin and extension of the hairless area; insufficiency of auricular framework; and distortion of the framework. Each topic must be well analyzed before surgical planning.