Reconstruction of the Ear Lobe

Earlobe reconstruction is a surgical procedure designed for people whose ears have been stretched or torn as a result of wearing earrings or previously made tunnels and for those whose earlobe has been cut or torn as a result of an accident.

Reconstruction of the torn earlobe - characteristics

The human ear is divided into external, central and internal. The outer ear consists of the external auditory canal, the lateral surface of the eardrum and the earlobe. The earlobe is made of elastic cartilage covered with skin, and between these layers there is no fatty tissue, so the skin is not movable relative to the ground, which is very conducive to mechanical damage to this area. From the outside, the umbilical cord is bounded by a hilum that forms a branch of the labarum in the front, and goes down into the labarum tail, and then into the earlobe. The flake, along with the adjacent part of the edging, have a different structure compared to the rest of the pinna, because they are deprived of the chondral skeleton, they consist only of a double layer of skin containing adipose and connective tissue. It is also intensely supplied with blood; its entire structure permeates the mesh of capillaries - wounds in this area can result in profuse bleeding. There are also many nerve endings in the earlobe.
Jewellery is usually a beautiful decoration, but unfortunately it can sometimes hurt the person who wears it. An example of this situation is the tearing of the earlobe, which most often happens to people who wear large, heavy earrings. Of course, this is not the only one, and only one of the reasons for this state of affairs. The tearing of the earlobe can also be the result of a traffic accident, it can arise when playing with a child, combing hair. Also in the case of removal of tunnels from the ears, you cannot expect spontaneous contraction, overgrowth of the remaining cavity. In very rare cases, the loss in the earlobe is the result of necrosis which developed as a result of the pressure of the skin of the area by a heavy clip. The tearing of the earlobe can be complete (and this type usually happens), then we deal with a flake divided into two parts, or incomplete - a hole of various sizes, bounded on each side by a stretched tissue. A torn earlobe may be difficult to mask, even if the patient has long hair. To get rid of such a cosmetic defect, a reconstruction of the earlobe is used, the end result of which is the ear with a completely unobtrusive scar. It is possible to reconstruct the leaflet in the state before the puncture, as well as the reconstruction with the creation of a buttonhole to carry the earring.

Reconstruction of the torn earlobe - benefits

The reconstruction of a torn earlobe is recommended in cases when the patient experiences discomfort, a decrease in the quality of life due to distortions in the ear or ear. The result of the treatment is an aesthetic ear with preserved tissue continuity, with thin scars that are not discernible, which, as time passes after the procedure, fades and disappears more and more. In a word, after about 4-6 months, the ear looks completely normal and it is difficult to notice that it has been treated in the past. It is also possible to re-wear jewellery in the ears - there are no contraindications to the piercing of the reconstructed leaflet after a certain time needed to heal the tissues. There is also a variant of the procedure allowing the earring to remain in the newly-operated ear.

Indications for the procedure

Complete and incomplete tearing of the earlobe formed as a result of stretching under the influence of weight, as a result of an accident, cutting, removal of tunnels and damage caused by reasons other than those listed.

Contraindications for the procedure

Contraindications to surgery include bleeding disorders and taking anticoagulants. For this reason, the doctor during the consultation may recommend a break from taking some medicines two weeks before the planned treatment.
A serious contraindication is also advanced cardiovascular disease with cardiac arrhythmias, accompanied by hypertension.
Tell your doctor if you are allergic to local anaesthetics.
Contraindication to the procedure is also unregulated diabetes, purulent lesions in the area of the planned surgery, because they threaten infection with the wound.
In pregnancy, as a rule, no procedures are performed which are not a necessity; reconstruction of the earlobe should be postponed until the child is born.

Before the surgery

Before the surgery it is necessary to consult a doctor who will perform the reconstruction of the torn earlobe. During the consultation, the patient will be asked about comorbidities and past medical conditions, medicines to be taken (you can bring packages), and whether he has undergone any aesthetic medicine or surgery in the past. After collecting the interview and conducting the examination, the doctor may order additional tests, depending on the patient's state of health. The condition of qualifying for the operation is a good general condition. During such consultation, the patient's expectations are discussed and the scope of the planned surgery is determined.
It is recommended to stop smoking.
Currently, when treating the external ear, that is also when reconstructing a torn earlobe, hair shaving is avoided if it is not absolutely necessary. The procedure should come with a freshly washed head. Clean hair is fastened and covered with a self-adhesive surgical sling.
Due to the fact that the operation is performed under local anaesthesia, the patient can afford to eat a meal, preferably light on the day of the procedure, unless the consultant advises otherwise.
Before the surgery, on the earlobe, in the area requiring reconstruction, the doctor performing the procedure marks the elements with a felt pen, which will have to be removed in order to prepare the petal for the aesthetic stitching.

Type of anaesthetic

The treatment of reconstruction of the torn earlobe in adults is performed under local anaesthesia; general anaesthesia is recommended only in cases of long-term surgery, in people with significant scarring of the operated area and in young children due to difficult cooperation.
During pre-ear surgery, premedication can be used - optionally, to calm the patient.
Local anaesthesia consists of local injections of a suitable local anaesthetic and a vasoconstrictor (to reduce bleeding of the operated area) in the area where the surgery will be performed.

How does the procedure work?

The operator's approach to the reconstruction surgery may vary to some extent depending on the individual needs and anatomical conditions of the patient. The treatment is discussed and planned during the initial consultation, during which the doctor also provides answers to any questions bothering the person who wants to undergo a reconstruction surgery. On the day you apply for the treatment, another consultation takes place, then the doctor marks out the elements he intends to remove to reconstruct the torn earlobe.
The duration of the entire procedure is about 30 minutes if it concerns one ear and 60 minutes if the reconstruction covers both ears. The surgical field is covered with sterile surgical sheets, the patient's eyes are covered. The operated area is thoroughly disinfected. The patient is conscious. The use of local anaesthesia requires that you wait a few minutes to allow the drug to absorb and start to work. After making sure that the patient feels comfortable and does not feel pain, it is possible to start the procedure. The physician performing the surgery performs cuts at previously marked borders, thus removing torn, scar tissue fragments. The type of damage to the earlobe - whether it is completely ruptured or missing is incomplete, and the surgical technique depends on the location of the defect. If there is an incomplete rupture of the earlobe, the reconstruction may take a different form, depending on the location of the lesion. If the removed gap is incomplete and located in the area of the upper 2/3 of the petal, it is possible to cut the same change, and then its stitching. If the damage, even if incomplete, exceeds the lower one-third of the petal, a similar procedure is suggested in the case of complete disruption. This damage development usually provides the best cosmetic effect.
The operator stabilizes the ear by grasping the back and bottom of the labarum with the hand or with a tool to facilitate access and make a more reliable cut because the earlobe is a very mobile structure. When the area is immobilized, using a scalpel, sharp scissors, a laser or an electrode that uses high frequency radio waves, the operator cuts the flap at pre-determined limits. At this stage, after removing the scarred, epidermal tissue, the defect remains in the shape of an inverted letter "V". It is especially important for the doctor to plan and carry out the cut in such a way as to spare as much healthy tissue as possible, so that the possible size difference between the two ears is not visible.
After the above-described tissue development, the operator sutures the resulting wound; Skin stitches are usually used, and subcutaneous stitches may also be used in the case of wide cutting boundaries to approximate and stabilize the reconstructed surface. The number of seams to be sewn may vary individually, but usually they are 3-4 seams.
In a situation where the patient depends on the earlobe to pierce the ear to wear, it is possible to use a technique that allows the wearing of a small piece of clothing directly after reconstruction of the torn earlobe. The earring, which can be used in the described procedure should be made of gold and its plug should be very large and set in such a way that it does not compress the ear too much. After previous disinfection, the antibiotic ointment is covered with a decoration and placed in the correct location between the seams. It is necessary to rotate the earring very often within the first 24 hours after the procedure, even several dozen times a day; he stays in the ear for about 3 weeks; after this time it is removed, disinfected and placed back in the same place, every day, until a correct, fully healed hole is made.
The tension of the stitches is adapted to the postoperative swelling of the operated area. After the procedure, a loose dressing is placed on the reconstructed earlobe.
After the procedure the patient can go home; hospitalization in the clinic is not necessary.

Time and course of convalescence

With proper wound healing, sutures are removed after about 7-10 days. The full cosmetic effect (normal-looking ear, small, pale, invisible scars) is achieved after approximately 4 to 6 months.

Effects after surgery

The reconstruction effect is visible immediately after the treatment. If the patient during convalescence conscientiously follows the instructions of his doctor, taking care of the postoperative wound in a certain way, the effect should be better and better over time. Using an antibiotic ointment and keeping the reconstructed flake as dry as possible, we prevent the development of an infection that would prolong the healing time. After approximately 7-10 days after the procedure, if the healing proceeds correctly, the sutures are removed. The picture of stitches is very fast and should not hurt. Initially, the scars after the procedure may be red and more visible, however, over time the skin of the area pales, the ear looks completely normal and the surgeon's intervention is not usually visible.

Recommendations after the procedure

Immediately after the procedure, a restrained dry area should be maintained for about 24 hours. During the first day after the treatment the dressing changes. It is recommended to reveal the wound as much as possible, apply a small amount of antibiotic ointment for 2 weeks. During the post-operative wound healing period, one should avoid the sauna, swimming pool, situations and activities during which a newly-operated area may be injured.
Sutures are removed after approximately 7-10 days after the initial assessment of the healing of the tissues. If soluble threads are also used during the operation, it is not necessary to remove these types of seams.
If the reconstructed flap remained pierced in order to wear the earring, the first months should be worn only with specially selected, light, small gold jewellery. You should not wear non-precious jewellery at this time. Wearing long, heavy earrings is highly inadvisable during the convalescence period. After full healing of the ear, you should also reduce the wearing time of heavily loaded jewellery that can stretch and tear the reconstructed flap.
If the ear has been completely reconstructed without leaving room for piercing, re-piercing is also possible. It is advisable, however, that the puncture of the petal should take place after a minimum of 2-3 months.

How long do the effects last after the treatment last?

If the wound was properly stocked and the patient conscientiously adhered to the instructions for the care of the reconstructed earlobe, the effect of the procedure is maintained for the rest of his life. It would be advisable to give up wearing heavy long earrings, or at least limit the time of loading the petal, as well as be careful when the ornament is in the ear.

How to avoid complications after the procedure?

A significant proportion of complications can be avoided by following the instructions that each patient receives after the procedure from the doctor who performed the reconstruction of the earlobe.

Possible complications after the procedure

The effect of local administration of the anaesthetic drug in the area affected by the described procedure may be temporary, reversible facial nerve palsy.
After the reconstruction of the torn earlobe, early complications such as bleeding, hematoma and significant swelling, redness and pain may appear, suggesting a developing infection in the operated area that may delay the wound healing process. Residual distortion is possible. Late complications include distortion of the earlobe, noticeable asymmetry between the two ears, the formation of keloid, loss of the earlobe.

How to prevent tearing of the earlobe?

There are a few rules that should be followed so that the first and the next burst of the earlobe can not be broken. Avoid carrying heavy earrings for a longer period of time. It is advisable to remove the earring from the ear when using the telephone, visit the hairdresser, before removing the upper garment, which requires pulling through the head (blouses, sweaters), also when playing with children. In small children, it is not advisable to wear large, hanging or circular earrings.

Author: Katarzyna Rzewuska, MD
Literature:
• Otolaryngology Head and neck surgery; Warsaw 2014; Juergen Theissing, Gerhard Rettinger, Jochen A. Werner
• Clinical Otolaryngology; Warsaw 2015; K. Niemczyk, D. Jurkiewicz, J. Składzień, C. Stankiewicz, W. Szyfter
• http://ispub.com/IJFP/2/2/12857
• http://www.ellman.com/PDF/publications/Surgical/Cosmetic%20Earlobe%20Eepair,%20Dr.%20Niamtu.pdf

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