Excision of Exposed Cartilage for Management of Mohs Surgery Defects of the Ear

Abstract

Cartilage of the ear is often exposed during Mohs surgical procedures. Fenestration of the cartilage with a skin punch has been recommended to stimulate granulation tissue where the perichondrium has been destroyed. This article describes an alternative method--the excision of a window through the exposed cartilage, fully exposing the perichondrium on the other side of the cartilage. This promotes the rapid healing by second intention or provides a vascular bed for immediate skin grafting. Also, aggressive excision of nonviable cartilage helps prevent chondritis or perichondritis.

The Incidences of Chondritis and Perichondritis Associated With the Surgical Manipulation of Auricular Cartilage

“…Regrettably, some surgeons may be hesitant to use these valuable donor sites because of apprehension concerning the potential infectious complications when manipulating cartilaginous tissues. 6 There are sufficient grounds to approach surgery on the ear with appropriate caution. Bacterial colonization with P. aeruginosa predisposes the ear to postoperative infectious complications.…”

“…[2][3][4][5] Despite the advantages associated with the use of auricular donor sites, a number of surgeons are occasionally reluctant to use auricular skin and cartilage graft donor sites because of concerns about the potential infectious complications of cartilage manipulation. 6 Increased bacterial colonization, especially with Pseudomonas aeruginosa, predisposes the ear to infections after dermatologic surgery. 7 In one series, the wound infection rate associated with dermatologic surgery was 12.5% for procedures involving the ear compared with 1.45% for procedures involving other anatomic sites.…”

Sekundärheilung im Gesicht

“…frü he De fek tre kon strukti on nach Tu mor ex zi sio nen mit to po graphi scher hi sto pa tho lo gi scher Kon trol le der Schnit trän der ist zwin gend er for derlich bei F per fo rie ren den De fek ten, F frei lie gen den Knor pel-und Kno chenstruk tu ren falls kei ne ent spre chen de Fens te rung zum Aus wach sen von Granu la ti ons ge we be er folgt [12,30], F frei lie gen den Blut ge fäßen, Ner venstruk tu ren so wie Au gen bul bu san teilen, F post ope ra tiv ge plan ter Strah len the rapie des Be hand lungsa re als, F pfle ge be dürf ti gen, bett lä ge ri gen Pa tien ten und nicht ge währ leis te tem postope ra ti ven Wund ma na ge ment, F auf Wunsch des Pa ti en ten.…”

“…Frei lie gen de Knorpe lan tei le kön nen ohne Ein schrän kung der Stütz funk ti on ent fernt wer den [12] oder flä chen haft frei lie gen der Knor pel wird un ter Ein satz ei ner Stan ze mit 2 mm gro ßen Bohr lö chern per fo riert. Sie ga rantie ren eine ra sche Gra nu la ti on der Wundflä che, aus ge hend von un ter dem Knorpel lie gen den Bin de ge we be.…”