Ear Surgery - Surgical Technique - "V" Resection for Squamous Cell Carcinoma
A squamous cell carcinoma has been previously biopsied. All of the visible lesion was removed. For this reason the stitches were left in place to be sure the correct location was resected.
A "V" shaped resection is outlined to remove the cancer. This type of resection allows the ear to be closed primarily without buckling of the inner cartilage.
Both sides of the ear are anesthetized using 1% Xylocaine with Epinephrine, injected with a 27 gauge needle
Using a #11 blade a through and through cut is made in the superior portion of the planned incision and carried through the helix.
The inferior portion of the resection is made.
The final defect. Note the exposed cartilage and that the auricular soft tissue is thicker on the posterior surface.
A 3-0 chromic stitch is used to close the cartilage layer. In the example, the needle is placed incorrectly. The knot should be placed in the thicker posterior tissue. If this stitch is completed the knot will be in the thin anterior tissue.
Final closure of the cartilage. Note that the stitch is placed so the knot is in the thicker posterior tissue.
Appearance after closure of the cartilage.
The posterior auricular skin is next closed with a 5-0 nylon stitch.
Final appearance of the posterior skin closure.
The anterior skin is closed with an interrupted 5-0 Nylon Stitch.
A 4-0 chromic stitch is placed deep in the crease (scaphoid fossa) inferior to the helix . The stitch in this area can be very hard to remove. without inadvertently reopening the closure.
The edge of the helix is closed.
Appearance of the immediate post-operative ear closure.