The replantation of ear parts is doomed to failure in most cases (Weerda et al. 1986). The overall success rate reported in the literature is approximately 30 %. First stage: Avulsed ear parts should be kept cool and clean by placing them in a moist paper towel or special box for delivery to the operating room. Small auricular composite grafts can be successfully replanted even after 24 hours, but necrosis increases with the size of the replanted part and the duration
Fig. 10.30 Auricular reconstruction after total amputation. First stage:
a The film pattern traced from the opposite ear is reversed to determine the precise position of the reconstructed ear (see Fig. 10.13). Its position is also determined by the auricular remnants. b The old wound is opened, the scars are carefully excised, and the skin is undermined. The old wound edges are freshened, and the cartilage framework (Ge) is implanted (see Fig. 11.3). c The wound is closed. The ear-lobe remnant is placed at the anatomically correct site, and the skin is coapted to the framework by a suction drain (S) and several bolster sutures.
of exposure to room temperature. The procedure described by Baudet (1972) and later by Arfai (Fig. 10.29) increases the raw surface in the mastoid area and promotes anterior revascularization by fenestrating the salvaged cartilage (Fig. 10.29a-c). Second stage (Fig. 10.29d): After 4-8 weeks the auricular skin flap (Fig. 10.29a, A) can be separated from the mastoid flap (Fig. 10.29b, c; B). The auricle is raised from the mastoid plane as in a total ear reconstruction, and the flaps are returned. Residual defects are covered with a thick split or full-thickness skin graft (Fig. 10.29d). The reported success rate is approximately 40% (Weerda and Siegert 1998). If the earlobe is missing, it is reconstructed by the Gavello technique (see Fig. 10.18).
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