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A Classification System and Surgical Algorithm for Pediatric Postburn Ear Deformities
Martin R. Buta
1,
2, Matthew A. DePamphilis
1,
2,
3, Branko Bojovic
1,
2, Richard J. Ehrlichman
1,
2, Daniel N. Driscoll
1,
2
1Shriners Hospitals for Children, Boston, MA, 2Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 3Boston University School of Medicine, Boston, MA
Background: The external ear’s outward projection makes this anatomically complex appendage susceptible to burn trauma. Up to 40-60% of facial burns involve the ear, frequently impacting function and aesthetics. The authors describe a new classification system and surgical algorithm for pediatric postburn ear deformities.
Methods: To inform classification of the most complex ear burn cases, a retrospective review was conducted on patients aged 0 to 21 years who underwent cartilage framework reconstruction between January 2004 to January 2021 at a specialized pediatric burn center. Medical records were screened and 54 patients (61 ears) who met study criteria were identified and patient demographics, procedural characteristics, and outcomes were analyzed.
Results: For postburn ear deformities (Table 1) involving total or near-total preservation of the ear’s anatomical structural elements (Type I and Type II deformities, respectively), scar release, local tissue rearrangement, and/or skin grafting are typically sufficient for optimal reconstruction. For cartilage defects involving less than or more than two-thirds of the helix (Type III and Type IV deformities, respectively), a partial to complete ear scaffold can be successfully reconstructed using a composite graft, conchal transposition flap, costal cartilage graft, or porous polyethylene implant.
Conclusions: The proposed classification system and surgical algorithm (not shown) for postburn ear deformities facilitate a tailored approach that addresses reconstructive course duration, anticipated aesthetic results, complication potential, and patient goals and expectations.
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