Plastic and cosmetic surgery

by Frederick Strange Kolle

Should the flap have been cut large enough to permit of lining its entire back this can be done, but care must be exercised not to cause a too abrupt folding over of the same, as gangrene is likely to result. The more slowly this freshening is accomplished the better will the result be eventually.

If, however, this flap will not permit of autolining, and its raw surface presents a healthy granulated appearance, recourse may be had to the transplantation of a flap from the arm upon it and fastened to the denuded edges of the aural flap.

As soon as healing has been established a number of delicate, often complicated incisions are made in the newly formed part of the ear to give it proper shape and size.

Kuhnt has obtained excellent results in a case where he employed a flap from the back of the ear, combined with two pedunculated tongue-shaped flaps taken from the cheek above and the neck below, which he twisted about back of the flap of the newly formed ear, so that their epidermal surfaces faced its raw surface with the object of giving greater thickness to the ear at that point.

At best, however, the restoration of an entire ear may be considered impracticable, and only in such cases where the greater part of the ear remains can cosmetic results be looked for.

In the illustration shown the author restored the upper third of the ear shown above the line drawn obliquely across the ear. Seventeen delicate operations were necessary to obtain the result (see [Fig. 115]).

Fig. 115.—Partial Restoration of the Auricle. (Author’s case.)

Where the loss of substance is not too great and along the helix of the ear, a flap can be taken from the back of the ear, leaving it attached at its cicatrized union with the primary wound, and sliding this flap upward or outward until the defect of the helix is overcorrected to allow for contraction and suturing the flap in its new position.

The secondary wound if too large to permit of direct union with sutures may at once be covered with a flap taken from the anterior border of the arm, or, if preferred, from the inner aspect of the calf of the leg. The wound occasioned by the removal of the graft can easily be closed by suture, leaving simply a linear scar of little consequence. Usually such defects of the rim can be hidden by the combing of the hair, especially in women.