Ear replacement surgery according to Fritsch

The otoplasty operation according to Fritsch is one of the minimally invasive procedures of oturgery, which Weerda calls special forms of auricular implantation operations.

history

Fritsch calls his method Incisionless otoplasty and published it under this name in 1995, 2004, 2009 and 2013.

Surgical method

From tiny skin openings on the back of the auricle, permanent, non-resorbable (non-dissolvable) threads are invisibly placed around the cartilage of the antihelix as mattress sutures using a special technique that was previously described by Kaye., Mouly and at the same time also by Peled, tightened and knotted. When the threads are tightened, the auricle moves towards the head. The small skin openings under which he positions the knots of the threads are closed with thin catgut threads. Fritsch pointed out that he could not correct all ears satisfactorily with this minimally invasive technique. That is why he combined them with traditional ear tips by pulling the ear towards the head in the upper and middle (conchal) thirds with threads that were anchored in the ear cartilage and periosteum of the mastoid. This corresponds to the conventional Furnas method. In the case of protruding earlobes, he sometimes also resorted to a technique of the traditional methods by opening the back of the earlobe and removing soft tissue from it. He found that his minimally invasive technique did not lead to satisfactory results in severe concha hyperpasia. This is how Fritsch described his method in 1995 and applied it to a total of 13 patients.

In the later publications, in which he did not mention the number of operated patients, Fritsch mentions that he blindly pricks, grooves or scratches the cartilage of the anterior antihelix (so-called scoring), sometimes deeply, sometimes completely incised, around the rebound forces to weaken the cartilage. He believed that this was the only way to achieve lasting results. This scratching technique was used before him by Kaye, Mouly, Stenström and at the same time by Peled. The Fritsch method thus represents a combination of a minimally invasive method that does not work on the cartilage, as used by Merck on several thousand ears operated by him, with the traditional Ritz technique according to Stenström and the traditional method according to Furnas.

Risks and possible complications

According to Fritsch: Little pain and discomfort. Infection, hematoma, swelling, thread rupture, epithelial inclusions with formation of small cysts.

Possible further risks according to Weerda: Cosmetically disfiguring cartilage edges along the anterior surface of the antihelix with too deep scratches or injuries to the cartilage skin, postoperative bleeding, hematoma , relapse (ears stick out again), hypersensitivity, pain to pressure and cold, pressure damage with tissue destruction ( necrosis ) when too tight Close-fitting, hard bandage, perichondritis (inflammation of the cartilage), greater asymmetry of the distances between the ears (see also chapter Otopexy ), possibility of injury to the facial nerves and the postauricular vessels when the connective tissue between the mastoid and ear cartilage is cauterized.

Individual evidence

1. ↑ Hilko Weerda: Surgery of the auricle. Georg Thieme Verlag, 2004, ISBN 3-13-130181-3 .
2. ^ MH Fritsch: Incisionless Otoplasty. Laryngoscope . 105, 1-11, 1995
3. ^ MH Fritsch: Incisionless Otoplasty. Facial Plastic Surgery 20, 267-70, 2004
4. ^ MH Fritsch: Incisionless Otoplasty. Otolaryngol. Clin. N. Am. 42, 1199-1208, 2009
5. ^ MH Fritsch: otoplasty without incision (Incisionless otoplasty. A review). J Aesthet Chir , 6. 203-208, 2013
6. ↑ BL Kaye: A simplified method for correcting the prominent ear. Plastic and Reconstr. Surg. , 40, 44-48, 1967
7. ^ R. Mouly: "Correction sans cicatrice des oreilles décollées." Ann. Chir. Plast., 16, 55-59, 1971
8. ↑ IJPeled: "Knifeless otoplasty: how simple can it be?" Aesth. Plastic Surg., 19, 253-255, 1995
9. ↑ Furnas, D. (1968). "Correction of prominent ears by concha mastoid sutures." Plast Reconstr Surg 42: 189
10. ↑ BL Kaye: A simplified method for correcting the prominent ear. Plastic and Reconstr. Surg. , 40, 44-48, 1967
11. ^ R. Mouly, Correction sans cicatrice des oreilles décollées. Ann. Chir. Plast. , 16, 55-59, 1971
12. ^ SJ Stenström: "A natural technique for correction of congenitally prominent ears." Plastic Reconstr. Surg. , 32, 509-518, 1963
13. ^ WH Merck: "The thread method according to Dr. Merck. J. Aesth. Chir. , 6, 209-220, 2013.
14. ^ SJ Stenström: "A natural technique for correction of congenitally prominent ears." Plastic Reconstr. Surg. , 32, 50 9-518, 1963

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