What is the best approach for pinna repair after a chunk of cartilage has been removed?

Pinna Repair After Cartilage Removal

The best approach for pinna repair after a chunk of cartilage has been removed is to use autologous cartilage grafting techniques, specifically with cartilage batten grafts to restore structural integrity and maintain the ear's natural contour.

Anatomical Considerations

When dealing with pinna defects involving cartilage loss, several factors must be considered:

• Location and size of the defect
• Amount of remaining cartilage
• Condition of overlying skin
• Functional and aesthetic goals

Surgical Approach Algorithm

Step 1: Assessment of Defect

• Evaluate the size and depth of the cartilage defect
• Determine if the defect is partial or full-thickness
• Assess the stability of remaining cartilage framework

Step 2: Graft Selection

For most pinna reconstructions with cartilage loss, the following options are available in order of preference:

1. Autologous cartilage grafting (preferred) 1

   • Batten type grafts from remaining septal or conchal cartilage
   • Provides excellent structural support and contour maintenance

2. Cartilage reconstruction techniques 1

   • Superior to temporalis muscle fascia for structural outcomes
   • Better graft integration rates (92.4% vs 84.3% with fascia)
   • Lower revision rates (10% vs 19% with fascia)

Step 3: Surgical Technique

For small to moderate defects:

1. Create appropriate incisions to access the defect
2. Harvest cartilage graft (typically from septum or opposite ear concha)
3. Shape the graft to match the contour of the missing segment
4. Secure the graft with non-absorbable sutures using "figure 8" sutures 1
5. Ensure adequate skin coverage over the graft

For larger defects:

1. Consider a two-stage reconstruction approach 2
2. May require costal cartilage grafting for extensive reconstruction
3. In cases with significant scarring, a superficial temporalis fascia flap may be necessary

Special Considerations

Prevention of Complications

• Chondritis prevention is critical 3
  • Use sterile technique
  • Consider prophylactic antibiotics
  • Ensure adequate blood supply to the repair site

For Recurrent Cases

• If dealing with recurrent seroma or hematoma in the pinna:
  • Consider cruciate incision technique which has shown excellent results with no recurrence 4
  • This approach allows for adequate drainage while preserving cartilage

For Cases with Limited Skin Coverage

• If skin is insufficient:
  • Consider tissue expansion 2
  • For extensive scarring, superficial temporalis fascia flap is useful

Follow-up Care

1. Apply pressure dressing for 3-5 days to prevent hematoma formation
2. Monitor for signs of infection or chondritis
3. Remove sutures at appropriate time (typically 7-10 days)
4. Assess for cosmetic outcome and functional results

Pitfalls to Avoid

1. Inadequate support: Failure to provide sufficient structural support can lead to deformity
2. Exposed cartilage: Always ensure cartilage is covered with vascularized tissue
3. Infection: Chondritis is the most feared complication and requires aggressive treatment
4. Hematoma formation: Can lead to cartilage necrosis and "cauliflower ear" deformity

By following this structured approach to pinna repair after cartilage removal, optimal functional and aesthetic outcomes can be achieved while minimizing complications.