Dermatologic surgery

“Pocket sandwich” dressing in auricular surgery Lindsey Schmidtberger1, BA, Abdel Kader El Tal2, MD, and Deborah F. MacFarlane3, MD, MPH

1 Department of Dermatology, University of Texas at Houston, Houston, TX, USA, 2 Department of Dermatology, American University of Beirut, Beirut, Lebanon, and 3 Department of Dermatology, MD Anderson Cancer Center, Houston, TX, USA

Abstract Background The auricular dressing presents a challenge to medical staff and patients alike. The task is to dress the ear, which may include exposed cartilage, in a manner that provides protection but does not distort auricular anatomy. Methods Two lengths of adhesive tape are sandwiched over the posterior and anterior aspects of the ear to cover the defect in an occlusive manner, creating a “pocket

Correspondence Deborah F. MacFarlane, MD, MPH MD Anderson Cancer Center University of Texas 1400 Pressler, Unit 1452, Room FCT11.6099 Houston, TX 77030 USA E-mail: [email protected]

sandwich”-type dressing. Results This method results in a dressing that can be used to cover a post-surgical defect on any part of the ear. It is inexpensive and easily reproducible by the patient. Conclusions The present dressing is non-bulky, easy to perform, and encases the ear in a pocket of adhesive tape. Further advantages are that it avoids the auricular distortion that may occur with overly bulky dressings, provides an occlusive environment, is esthetically pleasing, and comfortably accommodates eyewear. We highly recommend its use for ear wound defects.

Conflicts of interest: None.

Introduction The dressing of surgical wounds on the ear is challenging because of the ear's delicate anatomy. A desirable ear dressing is one that protects the operative site but avoids any distortion of the ear, an especially important consideration when cartilage is exposed. We have used this dressing for several years now without complications. We describe the method in the context of a typical patient who has undergone resection of a

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Figure 1 One of the 10 9 5-cm pieces of adhesive tape is placed on the posterior surface, with the extra tape protruding beyond the ear surface International Journal of Dermatology 2015, 54, 92–94

basal cell cancer from the conchal bowl, resulting in the exposure of cartilage. Materials and methods Once the defect has been dressed with antibiotic ointment and a non-adhesive dressing of choice, two lengths of adhesive tape measuring approximately 10 9 5 cm are cut. The first is positioned so that three-quarters of its surface adhere to the post-auricular surface; the remaining tape protrudes beyond the edge of the ear (Fig. 1). The second piece of tape is then

Figure 2 The second 10 9 5-cm piece of adhesive tape is placed on the anterior aspect and adhered to the first piece, creating a sandwich of adhesive tape ª 2014 The International Society of Dermatology

Schmidtberger, El Tal, and MacFarlane

Post-surgical dressing in auricular surgery

placed over the anterior aspect of the ear, and the two pieces of tape are sealed together so that the ear is sandwiched

Dermatologic surgery

patient, lightweight, and able to accommodate the patient's eyewear.

between them (Fig. 2). The corners of the dressing can then be rounded off (Fig. 3a–c).

Discussion

Results This method results in a dressing that can be used to cover a post-surgical defect on any part of the ear, and which requires only adhesive medical tape, a non-adhesive dressing of the user's choice, and antibiotic ointment. It is therefore inexpensive, easily reproducible by the (a)

Historically, bulky dressings have been used to cover auricular surgical defects.1 More recently, a variety of lighter auricular dressings have been presented in the literature.2–5 Some studies in patients who have undergone surgery to the auricular area have shown the use of a padded head dressing to be unnecessary and uncomfortable.1,6 Patients who forego head dressings after auricular

(b)

(c)

Figure 3 (a) The protruding tape is then trimmed and rounded off using scissors, to create (b, c) a lightweight, occlusive covering over the defect that accommodates the patient’s eyewear Table 1 Materials, advantages and disadvantages of the various types of dressing proposed for the occlusion of the post-surgical auricular defect

Materials used

Indications

Advantages

Disadvantages

“Pocket sandwich” ear dressing (present authors) Adhesive medical tape Non-adhesive dressing of choice Antibiotic ointment Scissors

“Trapdoor” ear dressing (Wasserman et al.2) Adhesive medical tape Two 4 9 4-cm pieces of gauze White petroleum Scissors

User-friendly ear dressing (Goldberg & Unkefer3) Tefla pad Scissors

Post-surgical auricular defect Can be used on any part of the ear Inexpensive Readily available materials Easily reproducible by patient Esthetically pleasing Accommodates eyewear Very lightweight Provides an adequately occlusive environment May be difficult for one person to trim

Post-surgical auricular defects

Post-surgical auricular defects Particularly useful for defects on the helix Readily available materials Easily reproducible by patient Very lightweight Tape does not contact patient’s skin

ª 2014 The International Society of Dermatology

Inexpensive Readily available materials Lightweight Provides an adequately occlusive environment

May be somewhat difficult for patient to reproduce at home Slightly bulkier Less esthetically pleasing Does not accommodate eyewear

May not be suitable in surgeries of the external auditory meatus Tefla is more expensive than gauze or medical tape

Malleable ear dressing (Godley4) Specifically created bandage of non-adherent silicone sheeting, layer of malleable metal, layer of cloth with adhesive Antibiotic ointment Liquid adhesive Post-surgical auricular defects

Easy to apply for the patient Very lightweight Esthetically pleasing Does not require changing for 5–7 days

Requires special manufacturing and materials for production (therefore likely to be more expensive) May not provide sufficient pressure Calls for skin contact with a liquid adhesive

International Journal of Dermatology 2015, 54, 92–94

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Post-surgical dressing in auricular surgery

surgery may have quicker returns to work or school without a significant increase in complications such as postoperative bleeding or hematoma formation, infection, or the early recurrence of ear prominence.1 In a comparison of the use and non-use of pressure bandages to cover postoperative auricular surgical defects, Castelli et al.6 showed that the use of pressure bandages can actually lead to bruising and erythema of the skin of the pinna without decreasing the likelihood of wound complications, such as hematoma formation and infection. Wasserman et al.,2 Goldberg and Unkefer,3 and Godley4 have proposed easy-to-perform, lightweight, more esthetically pleasing methods of dressing post-surgical auricular defects (Table 1). As the data in Table 1 show, our pocket sandwich ear dressing shares many of the advantages afforded by some of the other newly presented ear dressings in that it is inexpensive and simple and provides an adequately occlusive environment. However, the pocket sandwich dressing has the added benefits of being very esthetically pleasing and light in weight. It is an ideal dressing for surgeries on the external auditory meatus, is easy for the patient to

International Journal of Dermatology 2015, 54, 92–94

Schmidtberger, El Tal, and MacFarlane

reproduce at home, and also easily accommodates the patient’s eyewear. References 1 Powell BW. The value of head dressings in the postoperative management of the prominent ear. Br J Plast Surg 1989; 42: 692–694. 2 Wasserman DI, Tucker D, Zeltser R, et al. Trapdoor ear dressing for auricular surgery. Dermatol Surg 2008; 34: 567–570. 3 Goldberg LH, Unkefer RP. A technique for constructing a user-friendly ear dressing. Dermatol Surg 1997; 23: 1222– 1223. 4 Godley FA. Experience with the malleable ear dressing, a versatile silicone-lined bandage for the auricle. Ear Nose Throat J 2003; 82: 570–574. 5 Ross JK, Matti B, Davies DM. A silastic foam dressing for the protection of the post-operative ear. Br J Plast Surg 1987; 40: 213–214. 6 Castelli ML, De Lisi D, Marcato P, et al. Is pressure dressing necessary after ear surgery? Ann Otol Rhinol Laryngol 2001; 110: 254–256.

ª 2014 The International Society of Dermatology

"Pocket sandwich" dressing in auricular surgery.

The auricular dressing presents a challenge to medical staff and patients alike. The task is to dress the ear, which may include exposed cartilage, in...
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