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INTRODUCTION

Torn earlobe and enlarged pierced earlobe canals are a common consequence of wearing heavy earrings for a prolonged period of time (Fig. 64.1) as well as other factors such as trauma, heavy earrings, infection, low placement of piercing, pressure necrosis, etc. It occurs most easily in thin ear lobules. Drooping or easily torn earlobes may also be secondary to a congenital defect or trauma.

Figure 64.1

(A) Female with large tear defect of earlobe at the site of heavy earring. (B) Torn earlobe reconstructed by primary repair

KEY CONSULTATIVE QUESTIONS

  • Precipitating event of earlobe tear

  • History of keloids or hypertrophic scarring

  • Does patient desire to wear earrings again after the repair?

MANAGEMENT

There are numerous surgical methods to repair completely and partially torn earlobes. Different techniques are suited for different tears. Partial tears are more easily treated and can be corrected via side-to-side closure as well as punch excision and repair.

TREATMENTS

Figure 64.2

Repair of complete earlobe tear utilizing a Z-plasty to prevent dimpling of the inferior aspect of earlobe

Figure 64.3

One stage preauricular flap to repair earlobe deformities

Complete tears are more difficult to treat than partial tears. There are numerous different techniques that can be successful. Most commonly, the Z-plasty repair or interlocking Ls repair produce the best result.

  • Sterile preparation and technique

  • Local anesthesia should be injected into the repair site

  • The epidermis of the opposing edges of the tear wound should be excised

    • – Scalpel

    • – Scissors

  • Interrupted 6-0 epidermal sutures approximate and evert the wound edges of the anterior and posterior lobe

    • – Be certain to approximate the wound edges of the inferior rim of the ear carefully to avoid distortion or misalignment

    • – The wound edges should be under minimal tension

  • No subcutaneous sutures are used

  • Z-plasty repair (Fig. 64.2) or interlocking Ls repair on the rim will produce tissue approximation while preventing the dimpling of the inferior rim of the earlobe

  • Patients should be counseled to refrain from wearing earrings for 3 months following the repair

PITFALLS TO AVOID/COMPLICATIONS/MANAGEMENT/OUTCOME EXPECTATIONS

  • Meticulous attention to approximating the wound edges and the inferior rim of the ear are essential for a satisfactory result. Notching of the inferior rim of the earlobe can occur easily, significantly compromising aesthetic appearance

  • Caution in a patient with a history of keloids or hypertrophic scars

  • Patient should not wear earrings for 2 to 3 months after surgery

  • Wound strength is less than the original strength of the lobe. Avoid wearing ...

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