A Surgical Algorithm for Reconstructing Significant Pediatric Postburn Ear Cartilage Defects
Matthew A. DePamphilis1-3, Martin R. Buta1,3,4, Branko Bojovic1,3,4, Daniel N. Driscoll1,3,4
1Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospital for Children, Boston, MA; 2Boston University School of Medicine, Boston, MA;3Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA; 4Harvard Medical School, Boston, MA
Background: The external ear is a vulnerable appendage susceptible to injury in cases of facial burns. Its intricate architecture presents a formidable surgical challenge after burn injury, especially when scar tissue, impaired blood supply, and trauma to cartilage all influence reconstructive options. The authors share their institutional experience and provide a general guide for determining the most suitable surgical repair for various types of postburn ear cartilage defects.
Methods: A retrospective review was conducted on patients aged 0 to 21 years old admitted to a specialized pediatric burn hospital for postburn ear cartilage reconstruction from January 2004 to January 2021.
Results: The study cohort of 54 children (61 ears) who underwent ear cartilage reconstruction were an average age of 6.2 years at the time of burn injury; 59% were male birth sex and 63% self-identified as Hispanic or Latinx ethnicity. The mean percent total burn surface area (TBSA) was 34%, with flame (70%) the most common burn mechanism followed by electrical (15%), chemical (9%), and scald (6%). A shorter reconstructive course, minimal complication rates, and highly aesthetic results were achieved with a composite graft (9 ears) or conchal transposition flap (24 ears), which were employed in cases of small to medium-sized helical rim loss. When presented with large helical rim or full ear loss, although more complex, reconstruction with a construct was necessary. In most cases, our institution preferred porous polyethylene implantation (23 ears) over costal cartilage grafting (5 ears) as it eliminates age restrictions and donor site morbidity while also achieving aesthetically desirable results.
Conclusion: There is a steep learning curve to postburn ear cartilage reconstruction, however, with experience, proper planning, and an individualized approach, complication rates can be minimized and excellent functional and cosmetic outcomes can be achieved. Factors such as reconstructive course duration, complication potential, and anticipated aesthetic results should be discussed in detail with the patient to select an intervention that aligns optimally with their reconstructive goals.
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