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Increased Infection in Total Ear Reconstruction Patients with Patent External Auditory Canal Warrants a Perioperative Treatment Protocol
Andrew Vardanian, MD, Justine C. Lee, MD, PhD, Christina Federico, BA, James P. Bradley, M.D..
University of California, Los Angeles, Los Angeles, CA, USA.

Purpose: Total ear reconstruction for microtia is one of the most challenging procedures for a plastic surgeon and infection or exposure of a cartilage graft can jeopardize an outcome. After noticing that our ear reconstruction cases with a patent external auditory canal (EAC) were associated with more infections, we chose to 1) compare the incidence of infection with total ear reconstruction: no EAC vs. patent EAC; 2) determine if a protocol designed for reducing bacteria with a patent EAC was useful in reducing infection.
Methods: Microtic patients treated at UCLA with costocartilaginous grafts for total ear reconstruction from 2002-2011 were divided into 2 groups (n=79): 1) no EAC and 2) patent EAC. We used a 2-staged Nagata/Firmin technique. Signs of infection, need for antibiotics, need for surgical debridement, and/or loss of graft were recorded. Next, we designed a protocol for patent EAC patients who needed ear reconstruction including: preoperative ENT screening, operative cleansing (full-strength betadyne/antibiotic syringe wash), and perioperative antibiotics based on EAC culture swabs. Comparison was done between patent EAC ear reconstruction patients with and without the protocol (n=21). A patient/physician outcome survey (0-4) was also used.
Results: Part I: Patient ages (7.2 vs. 7.0 years) and number of procedures (2.8 vs. 3.0) were similar in the two groups. Higher superficial and deep infections (29% vs. 12%) and cartilage exposure (31% vs. 9%) was observed in patients with patent EAC. In addition, the need for surgical debridement (27% vs. 8%) and loss of graft was higher (7% vs. 1%). Routine swabs from EAC showed Staph Aureus and various atypical bacteria. Part II: Sterilization of the patent EAC was successful in reducing the need for subsequent antibiotics (42% less) and re-operative take backs (88% less). Outcome surveys showed the final result was better in the no EAC group and in the patent EAC with the sterilization protocol.
Conclusion: Patients who require total ear reconstruction with rib cartilage grafts and have a patent EAC are more predisposed to perioperative infections. A specific protocol for these patients designed to reduce infections has been created based on our experience.


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