Management of Postoperative Wounds Kaga K, Asato H (eds): Microtia and Atresia – Combined Approach by Plastic and Otologic Surgery. Adv Otorhinolaryngol. Basel, Karger, 2014, vol 75, pp 121–123 (DOI: 10.1159/000350980)
Postoperative Management of the Reconstructed External Auditory Canal Kimitaka Kaga National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
After construction of the external auditory canal (EAC) by inserting a skin tube in the second stage of a staged operation, insert colored silk gauze of 1 cm2 as a marking sheet on the eardrum at the far end of the EAC, and then insert many cylinders of gauze of 1 cm2 for compression. 10–14 days after surgery, remove all gauze under an operating microscope on an outpatient basis, and then insert new square gauze coated with antibiotic ointment to maintain compression. Repeat the same procedure 1–2 weeks later, until the reconstructed EAC becomes dry. The four aims of postoperative management of the reconstructed EAC are listed below (fig. 1). (1) Prevention of stenosis of the entire external ear. (2) Prevention of infection of the EAC. (3) Prevention of granulation of the EAC. (4) Prevention of stenosis at the opening of the EAC.
How to Cope with Four Problems of the Reconstructed External Auditory Canal
Infection of the Reconstructed EAC If infection develops, identify the causative bacterium with a bacterial test and, after disinfection, administer an appropriate antibiotic, both orally and as eardrops.
Downloaded by: Weizmann Inst. of Science 198.143.58.1 - 3/25/2016 3:58:40 AM
Stenosis of the Reconstructed External Ear Extend the duration of insertion of the small gauze, or insert in dwelling silicon tubes of different diameters. If stenosis cannot be prevented despite a prolonged period of postoperative treatment, revision surgery will be necessary to widen the external auditory canal (EAC).
Pus 1
2
Granulation 3
4
Fig. 1. Postoperative problems of reconstructed external auditory canal. (1) Totally stenotic, (2) infections, (3) growth of granulation, and (4) stenosis of the orifice.
In such cases, place small gauzes or an absorbable sponge (Merocel®) into the reconstructed EAC. However, repeat the treatment after 1 week because this material loses absorbency in about a week. Greater treatment care is needed if the infection is due to Pseudomonas aeruginosa or MRSA. Frequent disinfection with Isodine® is the most effective approach, and a nearby clinic or the parent should be asked to perform this procedure. Isodine® is available as both a solution and a gel; whichever is most appropriate may be used. Repeated otic instillation with Burow’s solution is also effective for infection.
Dilation of Stenosis at the Opening of the EAC There are two major causes of stenosis at the opening of the EAC. One is scar formation and the other is the influence of infection. Insert a small plastic tube to dilate the stenotic opening; this should be replaced with a larger plastic tube or ear mould when the stenosis has been expanded. Remember that stenosis can easily constrict the open-
122
Kaga
Kaga K, Asato H (eds): Microtia and Atresia – Combined Approach by Plastic and Otologic Surgery. Adv Otorhinolaryngol. Basel, Karger, 2014, vol 75, pp 121–123 (DOI: 10.1159/000350980)
Downloaded by: Weizmann Inst. of Science 198.143.58.1 - 3/25/2016 3:58:40 AM
Granulation of the Reconstructed EAC If pathological granulation develops at the disruption suture, site of skin defect, or site of infection, trichlol acetic acid or silver nitrate solution is useful to promote epithelialization and thus reduce the granulation.
Kimitaka Kaga National Institute of Sensory Organs, National Tokyo Medical Center 2-5-1 Higashigaoka, Meguro-Ku Tokyo 152-8902 (Japan) E-Mail [email protected]
Postoperative Management of the Reconstructed EAC
Kaga K, Asato H (eds): Microtia and Atresia – Combined Approach by Plastic and Otologic Surgery. Adv Otorhinolaryngol. Basel, Karger, 2014, vol 75, pp 121–123 (DOI: 10.1159/000350980)
123
Downloaded by: Weizmann Inst. of Science 198.143.58.1 - 3/25/2016 3:58:40 AM
ing to almost nothing within a couple of hours of early removal of the plastic tubes for compression. It is important to make a large opening for the reconstructed EAC during surgery to reduce the risk of stenosis of the EAC. Repeat surgery for repair often becomes necessary once stenosis develops.
Postoperative Management of the Reconstructed External Auditory Canal Kimitaka Kaga National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
After construction of the external auditory canal (EAC) by inserting a skin tube in the second stage of a staged operation, insert colored silk gauze of 1 cm2 as a marking sheet on the eardrum at the far end of the EAC, and then insert many cylinders of gauze of 1 cm2 for compression. 10–14 days after surgery, remove all gauze under an operating microscope on an outpatient basis, and then insert new square gauze coated with antibiotic ointment to maintain compression. Repeat the same procedure 1–2 weeks later, until the reconstructed EAC becomes dry. The four aims of postoperative management of the reconstructed EAC are listed below (fig. 1). (1) Prevention of stenosis of the entire external ear. (2) Prevention of infection of the EAC. (3) Prevention of granulation of the EAC. (4) Prevention of stenosis at the opening of the EAC.
How to Cope with Four Problems of the Reconstructed External Auditory Canal
Infection of the Reconstructed EAC If infection develops, identify the causative bacterium with a bacterial test and, after disinfection, administer an appropriate antibiotic, both orally and as eardrops.
Downloaded by: Weizmann Inst. of Science 198.143.58.1 - 3/25/2016 3:58:40 AM
Stenosis of the Reconstructed External Ear Extend the duration of insertion of the small gauze, or insert in dwelling silicon tubes of different diameters. If stenosis cannot be prevented despite a prolonged period of postoperative treatment, revision surgery will be necessary to widen the external auditory canal (EAC).
Pus 1
2
Granulation 3
4
Fig. 1. Postoperative problems of reconstructed external auditory canal. (1) Totally stenotic, (2) infections, (3) growth of granulation, and (4) stenosis of the orifice.
In such cases, place small gauzes or an absorbable sponge (Merocel®) into the reconstructed EAC. However, repeat the treatment after 1 week because this material loses absorbency in about a week. Greater treatment care is needed if the infection is due to Pseudomonas aeruginosa or MRSA. Frequent disinfection with Isodine® is the most effective approach, and a nearby clinic or the parent should be asked to perform this procedure. Isodine® is available as both a solution and a gel; whichever is most appropriate may be used. Repeated otic instillation with Burow’s solution is also effective for infection.
Dilation of Stenosis at the Opening of the EAC There are two major causes of stenosis at the opening of the EAC. One is scar formation and the other is the influence of infection. Insert a small plastic tube to dilate the stenotic opening; this should be replaced with a larger plastic tube or ear mould when the stenosis has been expanded. Remember that stenosis can easily constrict the open-
122
Kaga
Kaga K, Asato H (eds): Microtia and Atresia – Combined Approach by Plastic and Otologic Surgery. Adv Otorhinolaryngol. Basel, Karger, 2014, vol 75, pp 121–123 (DOI: 10.1159/000350980)
Downloaded by: Weizmann Inst. of Science 198.143.58.1 - 3/25/2016 3:58:40 AM
Granulation of the Reconstructed EAC If pathological granulation develops at the disruption suture, site of skin defect, or site of infection, trichlol acetic acid or silver nitrate solution is useful to promote epithelialization and thus reduce the granulation.
Kimitaka Kaga National Institute of Sensory Organs, National Tokyo Medical Center 2-5-1 Higashigaoka, Meguro-Ku Tokyo 152-8902 (Japan) E-Mail [email protected]
Postoperative Management of the Reconstructed EAC
Kaga K, Asato H (eds): Microtia and Atresia – Combined Approach by Plastic and Otologic Surgery. Adv Otorhinolaryngol. Basel, Karger, 2014, vol 75, pp 121–123 (DOI: 10.1159/000350980)
123
Downloaded by: Weizmann Inst. of Science 198.143.58.1 - 3/25/2016 3:58:40 AM
ing to almost nothing within a couple of hours of early removal of the plastic tubes for compression. It is important to make a large opening for the reconstructed EAC during surgery to reduce the risk of stenosis of the EAC. Repeat surgery for repair often becomes necessary once stenosis develops.
