Jessica Kierath 1, Suzanne Rea 2, Fiona Wood 3
1 Burns Service of Western Australia, Fiona Stanley Hospital, 12 Australind Street, Swanbourne, WA 6010, email@example.com
2 Burns Service of Western Australia, Fiona Stanley Hospital, Murdoch, WA Fiona.Wood@heath.wa.gov.au
3 Burns Service of Western Australia, Fiona Stanley Hospital, Murdoch, WA Suzanne.Rea@health.wa.gov.au
Burn injury to the ears present a unique reconstructive challenge. The skin is thin and firmly adhered to the underlying cartilage such that the cartilage is vulnerable to direct damage and secondary chondritis. Surgical intervention to debride and repair with skin grafting maybe inadequate with exposed cartilage. The use of vascularized skin flaps have been described in the acute phase to salvage the structure. However frequently the local area is injured limiting the donor site tissue. Further the results of ear reconstruction using fascial flaps and skin grafts are often distorted.
Understanding the vulnerability and the need to preserve the delicate structure the option of conservative management was explored.
Experience with two cases of full thickness burns affecting the ear which were treated conservatively will be used to illustrate an alternative to surgery as a viable option.
2 individual patient case studies, both with deep dermal/full thickness burns of the majority of the ear. The burns were treated conservatively, eschar left in situ allowing wound below to granulate and provide soft tissue cover of the cartilage.
Conservative management yielded aesthetically pleasing results in both cases.
By managing these patients conservatively they avoided a graft or flap, and as such had no associated donor site morbidity.
It is pertinent to remember surgery is not always the best option and that in some situations a better outcome can be achieved for the patient by watching and waiting.
Jessica Kierath is a service registrar in plastic surgery at Royal Perth Hospital. She has burns experience as a registrar in Princess Margaret Hospital, Royal Perth Hospital and Fiona Stanley Hospital. She is also an instructor for the EMSB course.