Earfold

from Wikipedia, the free encyclopedia

Earfold or the Earfold method (English ear "ear" and fold "fold") is a surgical procedure to create protruding ears. In contrast to all other ear replacement operations, metal implants are used instead of threads. In terms of surgical invasiveness, the EarFold method ranks between the invasive open traditional oturgery (7,8,9,10) and the closed minimally invasive thread method according to Merck (4,5) and other special forms of oturgery . The ears are cut open and skin is dissected from the cartilage, as in traditional donning operations, but to a lesser extent. Sometimes the cartilage under the detached skin is also poked or scratched to weaken it.

history

The technique of the Earfold method was first described in 2016 by Norbert V. Kang and Ryan L. Kerstein. In 2018, Kang and co-workers reported the results and potential complications of this method.

Surgical method

One or more skin incisions about 1 cm long are made on the front of the auricle, depending on how many metal implants are placed in the ear. From here, the skin on the front of the ears is lifted off the cartilage to create pockets of skin. Metal implants are inserted into these with the help of so-called inserters.

The metal implants are called earfolds. They are 5 × 15 mm in size and 0.15 mm thick. They consist of Nitinol , an alloy of titanium and nickel, and are coated with a 24- carat gold plating. On the side facing the cartilage, the implants have short, triangular, spike-like tips that penetrate the cartilage and thereby fix the implant after a few weeks. Due to their U-shape, the implants bend a non-existent or poorly formed anthelix , which moves the ear towards the head. The auricular cartilage beneath the implants is either left intact or poked or scratched, the latter to weaken it. The patient is allowed to check the new position of the ears in a mirror before the operation by temporarily placing so-called preFold positioners , which have the same curve as the implants, on the antihelical folds . The dimension of the ear attachment is determined by the curvature of the earfolds and their position along the antihelical fold. The new distance between the ears and the head that is created does not always correspond to the patient's individual expectations, because it is determined by a constant, predetermined bending of the implants. The incisions in the skin are sutured and covered with plaster strips.

The method is not suitable for all patients. If your ears have a large and deep ear canal entrance funnel (a so-called large cavum conchae ), which is often the cause of a protruding ear in combination with an inadequately developed antihelical fold, the placement of ears in the lower half of the ears is not possible or the placement results are unsatisfactory. Protruding earlobes cannot be placed.

In contrast to conventional otoplasty operations (see traditional otopex surgery and otopexy ) and the thread method , there are no publications on long-term results . The authors of the Earfold method point out that it is currently not possible to assess the extent to which recurrences, secondary deformations, defects, position shifts or rejection of the implants will occur.

Aftercare

Patients should not sleep on their ears for the first 4 weeks to prevent the metal implants from shifting. You must not smoke for 3 months so that there is no circulatory disturbance with the very thin skin over the implants. Contact sports should not be practiced. Earrings should be avoided for 2 weeks. You should not swim for the first 4 weeks.

Risks and possible complications

They are comparable to the methodology of traditional otopexy : irregularities; undesirable results; pointed ear at the top (so-called Spock ear); Secondary bleeding with hematoma in the skin pockets; Pain; Infection; Erosion of the skin; Allergy to the implants; Rejection of implants; hypertrophic scar , keloid on incisions in the skin; cosmetically disturbing formation of edges on the front of the auricle when the implants are rotated, greater asymmetry in the position of the ears; in the first few weeks the implants are shifted while lying on the ears; Visibility of the implants under the skin; Removal of the implants is more complex and difficult than removing sutures with other surgical methods.

literature

  • WH Merck: The thread method according to Dr. Merck . J. Aesth. Chir. Pp. 209-220, 2013
  • WH Merck: auricle correction without skin incision - the Merck thread method . In: K. Bumm (editor): Correction and reconstruction of the auricle. Springer, pp. 153–169, 2017
  • Hilko Weerda: Surgery of the auricle . Georg Thieme Verlag, 2004, ISBN 3-13-130181-3 .
  • SJ Stenström: A natural technique for correction of congenitally prominent ears . Plastic Reconstr. Surg., 32, pp. 509-518, 1963
  • SJ Stenström: Cosmetic deformities of the ear . In: Graff WC, Smith JW, eds. Plastic surgery: a concise guide to clinical practice. 2nd Ed. Boston: Little Brown & Co; Pp. 603-604, 1973
  • JC Mustardé: Effective formation of antihelix fold without incising the cartilage . In: Transactions of the International Society of Plastic Surgeons, Second Congress, AB Wallace. Baltimore: Williams% Wilkens; 1960
  • JM Converse, A. Nigro, FA Wilson, N. Johnson: A technique for surgical correction of lop ears . In: Plastic and reconstructive surgery (1946). Volume 15, Number 5, May 1955, pp. 411-418, PMID 14384519 .

Individual evidence

  1. ^ A b Norbert V. Kang, Ryan L. Kerstein: Treatment of Prominent Ears with an Implantable Clip System: A Pilot Study . In: Aesthetic Surgery Journal . tape 36 , no. 3 , March 1, 2016, ISSN  1090-820X , p. NP100 – NP116 , doi : 10.1093 / asj / sjv182 , PMID 26673575 , PMC 5127466 (free full text) - (English, oup.com [accessed May 26, 2018]).
  2. ^ A b Norbert V. Kang, Nilesh Sojitra, Sinisa Glumicic, Jacobus A. Vlok, Greg O'Toole: Earfold Implantable Clip System for Correction of Prominent Ears . In: Plastic and Reconstructive Surgery - Global Open . tape 6 , no. 1 , January 2018, ISSN  2169-7574 , p. e1623 , doi : 10.1097 / gox.0000000000001623 , PMID 29464160 , PMC 5811290 (free full text) - (English, ovid.com [accessed on May 26, 2018]).
  3. ↑ Video at wolterskluwer.http.internapcdn.net (MP4 file)