Amputation of the Ear
The ear can be amputated in a blunt trauma situation or may need to be amputated due to cancer of the ear, hematomas of the ear or infections of the ear. When ear reconstruction is necessary due to trauma, the construction depends on two factors.
The first is the circulation to the amputated part of the ear. You need enough arterial inflow to the amputated part in order for it to survive. Venous congestion after amputation can result in loss of cartilage. The second factor is the availability of skin and soft tissue coverage over the cartilage. If there isn’t enough skin, flap coverage may have to happen. This is more complex and has a higher failure risk.
Reconstruction of the Ear
When a reconstruction needs to happen after cancer of the ear, the trick for the surgeon is to match the size and shape of the ear to the other ear. Because the ears are not seen together, the size is not as important as making the ears have the same shape and the same landmarks. There are basic plastic surgery techniques the surgeon needs to understand in order to try and reconnect an amputated auricle.
Ear Cancer
About 800,000 people in the US develop skin cancer. Ninety percent are on the head and neck. Twelve percent involve the ear. Of ear cancers, 50-60 percent are squamous cell carcinomas, 30-40 percent are basal cell cancer and 2-6 percent are malignant melanoma. A third of all cancers of the ear extends into and corrupt the cartilage of the external ears. They require through and through amputation of the ear.
Ear Injury
The external ear is often injured because it is exposed beside the head. The most common external ear injury is a human bite injury at 42 percent, a fall at 20 percent and automobile accidents at 16 percent. Dog bites accounted for 14 percent of ear injuries. Most of the time, the traumatic amputation of the ear was partial, although total amputations can occur. If ear infections aren’t treated properly, then infection, deformities, and additional tissue loss are likely to occur.
Abrasions of the ear must be thoroughly cleaned and irrigated. All debris must be removed, even if it means sharp debridement. The wound must be covered with topical antibiotic ointment and sterile gauze. The antibiotic ointment and gauze need to be reapplied every day. Hydrogen peroxide should be used to remove crusted materials, including crusted blood. It should take 7-10 days to secondarily epithelialize the tissue.
Auricular avulsion happens when a part of the ear is pulled off the scalp or the rest of the ear. It is an uncommon event to amputate the entire ear and when it happens, it usually involves major trauma to that side of the head, neck, and face.
Blunt Trauma
Blunt trauma to the ear results from blows to the head. Hematomas to the auricle occur that must be drained and repaired. If not corrected, this leads to what’s known as “cauliflower ear“.
In one study, a case representation was shown on a complete reconstruction of a complete ear amputation. The arteries were connected and the soft tissue was placed to recreate an ear. The cartilage was too damaged to be replaced.
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