It is a very common problem in youngsters these days that uses large heavy metallic ear rings which is the trend today. The increasing practice of ear piercing by both females and males as well, has resulted in more and more requests for ear lobe repairs, either for inadvertent tears of the lobule produced by a pull on the ear ring or by traction on using heavy jewelry on the ear.
The area is prepared with betadine. The procedure is conducted after giving local anesthetic 4% lidocaine (1-2 ml).
The tear of the ear lobe, if incomplete, is extended downwards to complete it. The edges of the tear are then freshened (denuded of any tags or overlying epithelium if partial healing has occurred in an old tear) with either a number 15 blade or iris scissors. A stay suture is applied to the apex of the tear and held with a hemostat.
This approximates the edges of the raw area and can be held up, facilitating the placement of subsequent sutures. I use 5/0 Proline or Ethilon on a fine needle, either of which is non-reactive and easy to handle. The anterior layer of simple interrupted sutures is next applied.
A maximum of 3 or 4 sutures will be required for appropriate approximation. A skin hook, used to keep the skin edges everted, prevents any inversion of the skin edges, which may subtract from a good cosmetic result. Minimal undermining of the skin edges (1 mm) also helps with accurate approximation without invagination of the skin.
The tension of the ties needs to be adjusted to allow for the post-operative edema. Tying the apical stay suture last enables minor adjustments to be made and prevents the development of any acute angle at the apex. Frequent comparisons with the opposite (more normal) ear will enable the physician to obtain a close approximation. A loose dressing is applied, which can be removed an hour later and the incision left open.
Patients are encouraged to keep the wound exposed except when they take bath, cover it with antibiotic ointment.
The patients are asked to come to OPD if they notice increasing swelling, bruising or bleeding from the suture line suggesting inadequate hemostasis, spreading redness or throbbing pain, suggesting infection. Sutures are removed after 5-7 days. The patient is advised against wearing earrings for 1-2 months to allow adequate scar maturity, as earlier attempts will result in stretching of the non-resilient scar.
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