Earlobe Stabilization with 6-0 Suture for Repair of a Complete Split

Abstract

The authors have indicated no significant interest with commercial supporters.T he completely split earlobe is a common problem that is most often the result of sudden trauma or the downward progression of a partially split earlobe. Much of the literature addresses various repair techniques to optimize cosmetic outcomes and avoid pitfalls such as notching of the inferior margin due to scar contraction. Techniques range from a simple side-to-side closure to moreelaborate closures such as a Z-plasty (Casson's technique) and rotational flap (Effendi's technique). 1 Regardless of the repair method chosen, stabilization of the earlobe is critical for precise execution and an optimal outcome. In the following case, we employed 6-0 suture affixed to each inferior free margin of the split lobe to accomplish stabilization. This novel approach allowed us to impart tension in the exact amount and direction desired. It also gave us easier access to the anatomic site than manual manipulation or instrumentation such as a chalazion clamp or forceps.Side-to-side closure was chosen for repair of a leftsided, epithelialized, complete earlobe split on a middle-aged woman. Care was taken to match the anatomy of the right earlobe because this patient had a similar repair of that ear 1 year before. The design of the repair is essentially a triangle with the apex just superior to the defect. Fine adjustments were made by adjusting the width of the margins and by a slight offset of the triangle apex. After preparation of the field and anesthetization, a 6-0 Prolene suture was affixed to each inferior free margin of the defect. As a surgical assistant applied gentle tension, the margins were scored using a #15 blade (Figure 1), followed by excision using iris scissors (Figure 2). A single, deep, dissolvable suture was placed to approximate the wound edges, and complete closure was accomplished with vertical mattress sutures, ensuring exaggerated wound eversion and epidermal seal. No attempt was made to preserve the pierced canal. Figure 3 shows the repair 1 week later at suture removal.The literature is full of techniques for the repair of split earlobes. Stabilization of this floppy appendage is critical for any of these techniques but is only

Repair of Pediatric Split Earlobe Deformity With Anterior Straight-Line Closure and Posterior Z-Plasty

“…All techniques involve excision of the epithelialized inner margins of the cleft and then vary in the complexity of closure and whether or not the original piercing hole is preserved. A simple straight-line repair with or without addition of vertical mattress sutures at the lobule edge is still advocated by many as the simplest and most effective technique 2–5 . However, others argue that this method does not adequately prevent notching of the lobular free margin and have proposed techniques such as L-flaps, V-flaps, triangular flaps, rotation or rotation-advancement flaps, double skin flaps, and three-flap closures 3,6–17 …”

“…A simple straight-line repair with or without addition of vertical mattress sutures at the lobule edge is still advocated by many as the simplest and most effective technique. [2][3][4][5] However, others argue that this method does not adequately prevent notching of the lobular free margin and have proposed techniques such as L-flaps, V-flaps, triangular flaps, rotation or rotation-advancement flaps, double skin flaps, and three-flap closures. 3,[6][7][8][9][10][11][12][13][14][15][16][17] Another technique that has been described to elongate the repaired cleft and thus reduce the risk of notching is use of the Zplasty.…”