Burned ear: the use of a staged Nagata technique for ear reconstruction

Abstract

Four features, manifested in various combinations, characterise deformity in the burned ear: (i) the presence of scarred skin at the site of and surrounding the ear, with dramatic loss of skin elasticity; (ii) the presence of longitudinal scars of the pinna due to previous drainage of the perichondritis as an initial trial for saving the ear; (iii) absence of different components of the framework of the ear, mostly the helix/antihelix complex (the cartilage-containing part) with or without the ear lobule; (iv) scarred chest wall due to associated burns of the skin of the chest. In the face of these deformities, the surgical goals for auricular reconstruction include the following: (i) removal of the remaining cartilage of the burned ear, part or the whole of it in severe cases, because it may be a source of infection; (ii) wide exposure of the cartilage of the ribs through sufficient chest wall incision to overcome the severe fibrosis of the burned chest wall skin; (iii) creation of delicate smooth cartilage framework, free of sharp edges; (iv) creation of a skin pocket of sufficient size. Eight patients with a unilateral or bilateral deformity of the ear following burns were operated on during the period from May 2006 to July 2007, with a median age of 23.25 years. There was a good colour match between the reconstructed auricle and the surrounding skin. Patient satisfaction was high and the results were well accepted.