Indian Journal of Otology

ORIGINAL ARTICLE
Year
: 2012  |  Volume : 18  |  Issue : 3  |  Page : 154--155

A simple method of applying ear dressing in microtia patients


Vinita Puri, Nishant Khare, Narasiman Venkateshwaran 
 Department of Plastic Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Nishant Khare
Department of Plastic Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra
India

Abstract

Introduction: Numerous splints and ear guards have been described for dressing in microtia patients but each has its own merit and demerit. We have devised a simple method of applying such dressings on the operating table. Materials and Methods: A rectangular piece of lubricated dressing material like paraffin gauze or antibiotic impregnated dressing is cut. The dressing material is than split partially into one thirds in a staggered manner. The dressing material is then applied to the retroauricular sulcus. The fans of the dressing material are then turned onto themselves over the projecting ear which makes the dressing stable in its position. Results: The authors have been regularly using this dressing for reconstruction in all cases of microtia. The dressing stays firmly in place in the peri-operative period and is subsequently replaced by stents. Conclusion: It is a low cost, readily available, simple, fast and effective method of ear dressing in the peri-operative period for microtia cases.



How to cite this article:
Puri V, Khare N, Venkateshwaran N. A simple method of applying ear dressing in microtia patients.Indian J Otol 2012;18:154-155


How to cite this URL:
Puri V, Khare N, Venkateshwaran N. A simple method of applying ear dressing in microtia patients. Indian J Otol [serial online] 2012 [cited 2020 May 28 ];18:154-155
Available from: http://www.indianjotol.org/text.asp?2012/18/3/154/103444


Full Text

 Introduction



The reconstruction of a normal looking ear is one of the most challenging problems in Plastic Surgery. The final outcome of ear reconstruction is assessed by the symmetry in size and projection of the ear, the adequacy of the contour, and an adequate retroauricular sulcus. [1] Most of the surgeons dealing with microtia face the problem of loss of projection and obliteration of the retroauricular sulcus.

 Materials and Methods



A rectangular piece of lubricated dressing material like paraffin gauze or antibiotic impregnated dressing is cut. The vertical height is slightly greater than the vertical height of the ear with an adequate horizontal width. The dressing material is then split partially into one-thirds in a staggered manner along both the vertical borders [Figure 1]a. A slit is also made in the midline across both the horizontal borders. The dressing material is then applied to the retroauricular sulcus and the splits in the dressing material automatically fan out on both the surface. The fans of the dressing material are then turned onto themselves over the projecting ear, which makes the dressing stable in its position [Figure 1]b. The sulcus is then packed with sterile gauze pieces and a loose dressing is applied over it [Figure 1]c.{Figure 1}

 Results



The authors have been regularly using this dressing for reconstruction in all cases of microtia. The dressing stays firmly in place in the peri-operative period and is subsequently replaced by stents. The dressing if applied correctly serves the dual purpose of maintaining the retroauricular sulcus and ensuring good skin graft uptake.

 Discussion



In a normal ear, the deep retroauricular sulcus helps to retain the dressing while a shallow sulcus in microtia reconstructions makes a stable dressing difficult to achieve. Application of excessive pressure while applying dressing is detrimental as it further compresses an already shallow sulcus. It is important to maintain the sulcus at the desired level of projection in the immediate postoperative period till the skin graft stabilizes and a more rigid stent can be applied. Numerous splints and ear guards have been described but each has its own merit and demerit.

Objects as varied as rubber tubes, silicon splints, Foley's catheter and bulky dressings have been described to overcome this problem. [2],[3],[4],[5],[6] However, availability and other concerns regarding retainability of such stents is debatable. The dressing technique for the immediate postoperative period needs to be simple, reproducible, stable and cost-effective. As the skin graft has to be in contact with a lubricated dressing material, slipping of such dressings and stent is a common occurrence. The obvious solution is to tailor the lubricated dressing material itself in such a fashion so that it fits snugly and stably in the retroauricular sulcus. The technique described by the authors serves all these purpose and is a low cost, readily available, simple, fast and effective method of ear dressing.

References

1Karanth SK, Mokal NJ. Silicone Foley's catheter: A useful splint in ear surgeries. Indian J Plast Surg 2008;41:51-4.
2Tanzer RC, Chaisson R. A protective guard for use during reconstruction of the auricle. Plast Reconstr Surg 1974;53:236-8.
3Ross JK, Matti B, Davies DM. A silastic foam dressing for the protection of the post-operative ear. Br J Plast Surg 1987;40:213-4.
4Tegtmeier RE. A silicone foam ear dressing. Plast Reconstr Surg 1977;60:131-2.
5Yotsuyanagi T, Yokoi K, Urushidate S, Sawada Y. A supportive technique using a splint to obtain definite contour and desirable protrusion after reconstruction of microtia. Plast Reconstr Surg 1998;101:1051-5.
6Yotsuyanagi T. Compressive plastic splint for postoperative management of the ear. Br J Plast Surg 1993;46:622-3.