The thermally injured ear: a systematic approach to reconstruction.

The ears are special and unique structures that ordinarily are ignored during our daily routines. A thermal injury of relatively moderate proportions can irreparably alter their shape and appearance. Many reconstructive techniques have been garnered to restore these delicate structures. Herculean efforts will consistently fall short of these goals if tissue preservation is not in the forefront of our treatment protocol. Iontophoresis coupled with topical antimicrobial agents have been shown to ameliorate cartilage loss, allowing for delayed operative intervention, when more consistent results may be obtained. Early radical resection of ear soft tissue or structural cartilage should be an endeavor of last resort in all but a few instances, such as unresponsive suppurative chondritis. Segmental restoration of the injured ear allows for dismantling of the various parts to recreate the whole. A facsimile of the original is possible if the major visible distinguishing landmarks are salvaged. Flap resurfacing of exposed cartilage yields closer tissue match, color, and texture, and it affords a greater proclivity for survival than does graft closure. Sacrifice of the helical lip relegates the ear to that of a flat, less-than-optimal appearance. Tissue expansion coupled with cutaneous flap closure will usually preclude this situation. Skin grafting is a valuable tool in our armamentarium but should be used judiciously in situations where graft coverage is either necessary or desired to produce enhanced results. In such instances, the thickness of the graft must be considered, ranging from an almost translucent quality for the antihelix to that of a much thicker graft for the helix. Application and direction of the graft will be determined by the underlying surface contours. Until the reconstruction has been completed, burn patients and their families usually do not view the injured ear that has been snatched from the fires of adversity. The unveiling frequently effects a felicitous atmosphere, because they perceive a relatively normal-looking ear. The final result is all that matters.