Repair of the Split Earlobe, Ear Piercing, and Earlobe Reduction

Side-to-side closure

This technique is illustrated in Figures 48.3 and 48.4 . The split earlobe is stabilized with a chalazion clamp during the cutting. Both sides of the epithelialized skin of the split are excised with narrow margins anteriorly and posteriorly with a no.15 surgical blade. Care is taken to avoid cross-hatching of the excision at the ends of the split, or excising unequal length of the split edges, which will result in a dog-ear deformity. The resulting defect is closed with simple side-to-side interrupted sutures on both the anterior and posterior surface of the earlobe. Absorbable 5-0 or 6-0 subcutaneous suture may also be used but is not necessary. (See Video 48.1 .)

The punch technique ( Fig. 48.5 ) is a variant of this for enlarged round pierced canals of <4 mm in diameter. The epithelium-lined edges of these pierced canals are excised by a punch while the earlobe is stabilized with a chalazion clamp. The resulting round defect is closed as noted above. This technique is not recommended for a split larger than 4 mm in diameter because dog-ear deformities arise upon suturing. The suture line may be vertical or horizontal depending on the shape of the ear, but the horizontal line may be more supportive of the earring load in the future.

Parallel opposed flaps (Reiter & Alford's technique)

Two opposing flaps are created on the anterior and posterior surface of the earlobe. Each flap is based alternately on the medial edge or the lateral edge of the split. The flaps are pulled through the split and attached to the freshened surface on the opposite side, which resulted from the creation of the other flap ( Fig. 48.6 ). The use of “purse-string” technique following a full-thickness elliptical excision in the repair of a partially split earlobe has been reported.

Repair of the completely split earlobe without preservation of the pierced canal

All techniques described below begin with careful planning followed by a critical excision of the slit in the lobule to obtain the desired results. The split earlobe is stabilized with a chalazion clamp during the excision. Both sides of the epithelialized skin of the split are excised with narrow margins anteriorly and posteriorly with a no.15 surgical blade. Care is taken to avoid cross-hatching of the excision at the superior end of the split, or excising unequal length of the split edges. (See Video 48.2 .)

The completely split earlobe can be repaired with a side-to-side closure. Vertical or horizontal mattress sutures are placed on the inferior rim of the earlobe to create wound eversion and reduce the risk of notching. Simple interrupted or mattress sutures may be used for the rest of the surgical line ( Fig. 48.7 ). Undermining the wound edges 1 mm prior to approximation to maximize wound eversion can be useful.

A small Z-plasty of the earlobe at the inferior pole of the repair may diminish scar formation and contraction, further reducing the risk of notching ( Fig. 48.8 ). Z-plasty may be used on the anterior skin of the earlobe and a vertical linear closure on the posterior surface if this helps attain the desired lobule configuration. The Z-plasty may be widened to an L-plasty, and can be performed with or without reconstruction of the pierced canal in a similar way and closed with simple interrupted sutures. If a canal is desired, a small flap at the superior end of the split is preserved and turned over and stitched on the anterior and posterior aspects. Both Z-plasty and L-plasty repairs prevent notching at the inferior border of the earlobe because the line of scar contracture is broken up. Enlarging the arms of the L-plasty ( Fig. 48.9 ) creates a triangular flap on the anterior surface of one edge. The posterior surface of the other edge is cut in the same way with a similar amount of tissue excised. The resulting triangular flaps overlap. Sutures are placed on the anterior and posterior sides with the consequent Z-suture line at the inferior rim of the earlobe. This technique also staggers the scar on the free border of the earlobe to avoid notching.

A single layer side-to-side closure with Z-plasty at the inferior margin of the earlobe ( Fig. 48.8 ) allows redirection of the vector of the wound contraction to decrease the risk of notching. Tip stitches are not required because the tips of the flaps are very small. The scar line of the Z-plasty is concealed within the inferior rim of the earlobe and stitched with simple interrupted sutures. If a canal is desired, a small flap as described above can be created.

Two V-flap variants may be of use. In one, a 3-mm V-shaped socket is cut from the fat on one side of the split earlobe. On the other side of the split earlobe, an inverted V-shaped joint is cut into the fat to receive the opposite side. The flaps are stitched with simple interrupted sutures ( Fig. 48.10 ). An alternative to this is the partially incised V-plasty which augments the earlobe's thickness as two de-epithelialized triangular areas are defined along the edges of the split. The base of the triangle is placed on the inferior rim of the earlobe and its apex pointed to the superior part of the split. These two triangular areas are de-epithelialized and the raw areas are moved to overlap each other, resulting in an increased thickness of the earlobe. The suture lines are placed on the anterior and posterior surface and they run obliquely rather than overlap each other ( Fig. 48.11 ).

Rotational flaps can be used if the lower border and the lateral edge of the lateral part of the split are excised to distances that will fit a rotational flap from the medial part of the split ( Fig. 48.12 ).

Repair of the completely split earlobe with preservation of the pierced canal

There are several techniques to repair the split earlobe with preservation of the pierced canal – for example, the skin edges can be joined below the pierced canal, or a flap can be used to create an epithelialized canal. These techniques may be used in the repair of partially split earlobes if desired. Earrings, or a non-absorbable material such as 1-0 or 2-0 nylon sutures, are used to maintain the newly formed canal.

Preservation of skin at apex of the split earlobe allows the split to be preserved with a side-to-side closure similar to that shown in Figure 48.7 , except that the untraumatized upper pole of the canal is left in situ.

Creation of a flap from a lateral portion of a split lobe uses skin at the upper end of one side of the split to form a flap ( Fig. 48.13 ) whose superiorly based skin is trimmed to the appropriate length, turned, and sutured to the op­posite side of the split to form a pierced canal. A suture-free floor of the newly formed canal minimizes the risk of split recurrence. This can be combined with a Z-plasty as described above to prevent notching. Many variations on these techniques have been described.