Repair of enlarged pierced-ear openings.

Enlarged pierced-ear openings are problematic for patients because they limit jewelry selection. Patients' most common complaint is dissatisfaction with their inability to wear ear studs. Additionally, significant enlargement makes possible the development of a through-and-through cleft because only a narrow bridge of tissue remains at the inferior edge of the ear lobule (figure 1).

[FIGURE 1 OMITTED]

The technique for repair is based on the size of the hole. Simple circumferential removal of the inner epithelial borders with subsequent reapproximation of the deepithelialized edges can repair most mildly to moderately enlarged holes. However, for patients with larger openings, closing the entire length of the hole will result in the creation of a notch at the interior border of the ear lobule secondary to scar contraction. To prevent notching, a scar-lengthening procedure, such as a Z-plasty, is added to the repair.

After injection of local anesthesia, the thin bridge of tissue is excised, and the free edges are deepithelialized. The edges are then reapproximated with nonabsorbable sutures (figure 2, A). Next, a Z-plasty is designed on the inferior border (figure 2, B). The Z-plasty flaps are elevated, transposed, and then sutured (figure 2, C). The edges will become edematous, but the sutures are ready for removal 5 to 7 days after surgery.

[FIGURE 2 OMITTED]

After 4 weeks, the area is typically well healed (figure 3, A and B). At this time, the ear is repierced; the exact site of the new piercing is determined by the patient's preference (figure 3, C). The stud is kept in place for 6 weeks, after which earring selection and wear are unrestricted.

[FIGURE 3 OMITTED]

From the Constitution Plastic Surgery Center, Albuquerque, N.M.