Case 12 Wedge Excision of the External

Malignant tumors of the skin of the external ear often invade the underlying cartilage or perforate through to present on both sides of the external ear. These lesions require a through-and-through excision of a portion of the pinna to remove the tumor

Figure 4-16. A The patient has a recurrent basal cell carcinoma of the pinna involving the underlying cartilage and presenting mainly on the posterior aspect. A wedge-shaped area of excision has been marked out. B, The full-thickness surgical defect showing retraction of the skin edges over the cartilage. C, The surgical defect is closed primarily in layers.

Figure 4-16. A The patient has a recurrent basal cell carcinoma of the pinna involving the underlying cartilage and presenting mainly on the posterior aspect. A wedge-shaped area of excision has been marked out. B, The full-thickness surgical defect showing retraction of the skin edges over the cartilage. C, The surgical defect is closed primarily in layers.

satisfactorily. Surgical defects resulting from excision of one-third of the vertical height of the pinna are suitable for primary closure by approximating the edges of the surgical defect. The height of the pinna is reduced, but the esthetic result is acceptable.

The preoperative appearance of the anterior surface of the pinna of a patient with a recurrent basal cell carcinoma involving the underlying cartilage mainly presenting on the posterior aspect is shown in Figure 4-16A. The lesion involves the helix and the underlying cartilage.

A plan of surgical excision is outlined by an incision drawn to resect a wedge of the ear with the apex of the wedge in the retroauricular skin crease (see Figure 4-16A). A similar incision is marked out on the anterior aspect of the pinna so that the apex of the surgical defect meets at approximately the same point both anteriorly and posteriorly. Excision is made with a scalpel in a through-and-through fashion along the pre-drawn skin incision. A wedge of the pinna is excised, including the skin of the anterior aspect, the cartilage beneath as well as the skin of the posterior aspect until the two skin incisions meet at the apex of the wedge. An extra margin of the cartilage is removed to facilitate skin closure. The skin edges usually retract over the cartilage immediately following excision of the tumor (Figure 4-16B).

Wedge excision of the pinna is a very acceptable and satisfactory operative procedure for lesions requiring through-and-through excision of any parts of the external ear. Primary closure is possible for defects not exceeding one-third of the vertical height of the pinna (Figure 4-16C). Larger defects are not suitable for primary closure.

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