The London Centre for Ear Reconstruction
Correction of Previous Surgery
After surgery to the ear
About one third of the procedures undertaken by Mr Gault is to correct deformities due to previous surgery undertaken elsewhere. Good results can nevertheless be achieved even in severe cases. Any operation around the ear can lead to a destructive infective episode. The ear canal is sometimes colonised by potential pathogens, particularly a bacterium called pseudomonas, and great care should be taken to clean the recesses of the ear before surgery. The ear can be lost after a procedure as simple as eardrum reconstruction. Eczema behind the ear should be treated before surgery as organisms within the rash can lead to significant destruction. Surgery should NEVER be undertaken around the ear area in the presence of a rash.
after failed bat ear surgery pre-op
post-opAfter surgery for prominent ears
The most common post-surgery problem, however, is related to bleeding which develops after bat ear correction (surgery for prominent ears), after the use of cartilage scoring techniques. Although scoring surgery can be successful in most cases, haematoma formation is unpredictable, and in a small but significant number of cases, the ear becomes severely deformed.
after failed bat ear surgery pre-op
after ear reconstructionTotal ear reconstruction is sometimes necessary
Bleeding and tight bandages alone can cause tissue loss because of the effects of increased pressure on the tissues. If infection develops in the small pool of blood which collects, then this can worsen matters. The suture technique for correction of prominent ears is the safest, and when combined with a fascial flap (Gault technique), the most reliable. In the United Kingdom, compensation for ear loss after failed pinnaplasty surgery is in the region of £20- 40,000.
buckled rim after pinnaplasty pre-op
post-opComplications of scoring surgery
- Deformity
- Rim buckling and rim kinks
- Over done set back (telephone ear)
- Loss of balance between the ear thirds
- Long and thin shapes sometimes result
- Pain
- Unexplained
- Chondrodermatitis
- Loss
- Skin
- Ear segments
- Hole in ear
- Destruction of antihelix
telephone deformity pre-op
post-opPiercings
The recent trend to pierce the upper part of the ear has led to a number of cases of chondritis, an infection of the cartilage. Pseudomonas infection is a common culprit. Chondritis, once established, often causes significant destruction and collapse of the ear. The majority of patients are also smokers.
piercing deformity pre-op
post-opTotal ear reconstruction is sometimes necessary
Piercings of the lobe often elongate and sometimes cut through the lobe, especially when very heavy or base metal earrings are worn. Repair is relatively simple and usually possible under local anaesthetic.
elongated piercing
immediately post-opKeloid scarring
Keloids of the ear sometimes develop if an attempt to set back the ears has been achieved by a skin-only technique which puts the margins of the wound under too much tension. Sometimes even a slight scratch can lead to keloid formation. It is normally possible to directly excise the keloid and to keep future scarring at bay with a combination of steroid injection and laser treatment.
Keloid
post-opAfter resection of Cancers
Defects which result from the resection of small tumours of the ear can be reconstructed with skin flaps alone. When a large portion of the ear is resected, however, the missing cartilage must be replaced to provide structural support. Malignant melanoma and squamous cell carcinoma are known to merit significant margins of clearance but even the slow growing basal cell carcinoma, which is not conventionally recognised as such a threat, can cause massive destruction, particularly in the area behind the ear. In the age group that generally present with auricular tumours, some patients will opt to have a prosthetic ear fitted.
cancer of the rim pre-op
after reconstructionCancer of the ear also presents in a number of younger patients, many of whom are not willing to consider a prosthetic solution. Autogenous ear reconstruction after extensive resection can be a great challenge, but refinements of technique developed in the last decade have improved the results considerably.
after amputation for melanoma
post-opFailed ear reconstruction
Ear reconstruction is a surgical challenge, but especially when previous attempts have failed. Good results can often be achieved even after a number of failed procedures.
after failed reconstruction
post-op