Acquired ear defects

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Trauma to the ear

Trauma may be physical or chemical as in thermal injury, or it may be mechanical as in wrestling, boxing, motor vehicle accidents, brawling, sports or job-related accidents, pierced ears, and human or animal bites.

Hematoma of the ear (Cauliflower ear)

The main complication of blunt trauma of the ear is the formation of hematoma. Blunt trauma (or excessive traction on the auricle) causes a shearing force that separates the cartilage from the overlying perichondrium. The force also tears blood vessels in the perichondrium. Blood fills the space between the perichondrium and cartilage and further separates the cartilage from the perichondrium, producing a convex surface that replaces the normal contour of the lateral surface of the ear.

Laceration of the ear

Lacerations of the ear may be minor to extensive. Clean lacerations caused by sharp objects are repaired using 6-0 nylon sutures with exact approximation of the edges. When the skin edges are crushed, minor débridement of the edges may be necessary. When the skin and the cartilage are involved in a clean laceration, the author prefers to approximate the edges of the cartilage and to do skin-to-skin repair. When the helical rim is involved, a key suture should be placed initially at the rim and

Flame, flash, blast, scalds, and steam burns

Burns of the ear invariably demonstrate a mixture of the three degrees of burn (Fig. 3). They are characterized by central coagulation, with peripheral areas of stasis and hyperemia [9], [65]. Thermal deformity of the burned ear may result from direct thermal injury. Because the cartilage is avascular, it accumulates its nutritional substance from the overlying perichondrium [51]. Disruption of this mechanism propagates further tissue loss and deformity [67]. Chondritis may develop, leading to

Keloid

Keloid is defined as a benign tumor of dense fibrous tissue, developed in the dermis as an excessive overaccumulation of collagen during the healing process [76]. It represents a failure of the normal check reins of healing.

The cause of keloid is unknown. Excessive scar tissue was described in the Smith Papyrus in Egypt about 1700 BC [13]. Trauma to the dermis is always the inciting factor. This trauma may be caused by surgical incision, burn, laceration, pustules, ear piercing, and even spider

Actinic keratosis: solar or senile keratosis

This is the most common premalignant lesion [77]. It is rare in dark-skinned people [77]. It appears as a discrete or slightly elevated, well-circumscribed, brown or red lesion found primarily on exposed surfaces.

Treatment consists of (1) prevention, by the use of sunscreen creams and avoiding exposure to the sun; (2) surgical excision; and (3) curettage, electrodesiccation, liquid nitrogen, and 5-fluorouracil. The percentage of actinic keratosis that progresses to invasive squamous cell

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      The complex and elegant contours of the auricle pose a formidable challenge to the surgeon attempting reconstruction.1 Acquired auricular defects frequently result from trauma in the form of lacerations, bite injuries, and burns.2 Thermal injuries to the ear are among the most difficult to repair because they are often characterized by loss of skin elasticity secondary to scarring and loss of cartilaginous support, scarring of potential graft and local flap sites, and perichondritis with cartilage loss.3

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