Plastic and cosmetic surgery

by Frederick Strange Kolle

Where the injury is one of incision or laceration without loss of the part, the site should be cleansed gently but thoroughly with a boric-acid solution, and the free torn edges brought together with fine silk sutures. If the cartilage projects unduly into the line of union it should be trimmed away with a fine pair of scissors (Roser). Wounds of such character usually heal well, even if the pieces hang loosely by threads of skin, a linear indent of cicatricial tissue usually marking the traumatic separation of the cartilage.

In the negro where razor cuts about the ear are often seen, a hypertrophic scar or keloid is liable to result, even to the extent of involving the punctures of the suturing needle.

It is advisable to save all that is left of the injured member, even if entirely severed, with the hope of obtaining union, since the rebuilding of even part of an ear is by no means an easy matter, owing to the complicated formation of the cartilaginous frame.

Wounds about the meatus are liable to result in stenosis, which should be guarded against by packing of small strips of gauze or in the case of loss of substance immediately about the orifice by the employment of a sliding flap taken from the skin of the vicinity or by the transplantation of a nonpedunculated skin flap taken from some other part of the body and sewn into place.

RESTORATION OF THE AURICLE

If a loss of substance of the auricle cannot be avoided, the surgeon must rely upon otoplastic means to make up the deficiency.

For the best cosmetic defects it is desirable to have as much of the cartilage remaining as possible. The stump of the ear is freshened at its outer margin with the bistoury and the frontal skin carefully dissected away from the cartilage to the extent of a quarter inch.

A flap, one third larger than the defect to be supplied, is now outlined on the skin back of the ear in such a way that the flap included therein will not be subjected to too much torsion.

This flap must necessarily vary in shape and size, according to the nature of the deformity to be corrected. It may even extend into the hair of the scalp over the squamoparietal region of the head or a part of the neck laterally and below the ear.

This flap, after careful estimation as to size, should be dissected up freely down to the periosteum, leaving a bridge of tissue at the point where the least resistance will be caused after its free end has been sutured to the remains of the ear.