Portal de Periódicos da CAPES

A safe and simple post-operative dressing for bat ears

1962; Elsevier BV; Volume: 15; Linguagem: Inglês

10.1016/s0007-1226(62)80064-2

1465-3087

Michael N. Tempest,

Poxvirus research and outbreaks

AFTER most facial operations dressings are unnecessary, but in the correction of bat ears the post-operative dressing is important for the following reasons :--I.Immobilisation.--Thetissues of the ear may require extensive mobilisation, resection, and local readjustment, and must be maintained in their new position without displacement until consolidation is established--a process which takes some ten to fourteen days.2. Obliteration Of Dead Space.--Unlessdead space is effectively obliterated a hmmatoma may spoil a potentially good repair.Should infection supervene the result may be disastrous.3. Protection.--For social and psychological reasons mest bat ear operations are carried out in young children between the ages of 5 and 7 years.These children are boisterous, often aggressive, difficult to confine to bed, fond of pillow fights and other games which might have been specially designed to endanger the surgeon's handiwork.Nor must one forget the "... things that go bump ill the night" as a restless child tosses and grinds his head against the pillows or mattress during sleep.To deal with these potential hazards an effective type of protective pressure dressing is essential.Every surgeon has his own particular modification, but the following basic type of dressing is widely used in most plastic units in this country.A single layer of tulle gras or paraffin gauze is placed over the external ear and in the post-auricular sulcus close to the suture line.The contours of the ear are then carefully packed with pieces of fluffed flavine and paraffin wool.A gauze pad and a firm crepe bandage are then applied.Strips of adhesive strapping are often added to prevent " tucking" of the folds of bandage but this manoeuvre is rarely satisfactory (Fig. I).It would seem better to make a light closely fitting helmet with plaster of Paris bandages.It is usually the surgeon's intention that this dressing should remain intact and undisturbed for ten to fourteen days when it is taken down and the sutures removed.Experience has shown that this method has several disadvantages :--I.It is extremely easy to apply the crepe bandage too tightly on an ana:sthetised child.Unless there is adequate padding, not only over the ears but also over the forehead, areas of pressure necrosis may appear at one or all of these sties.2. To avoid this complication, the crepe bandage may be applied too loosely (Fig. 2).This defeats the whole purpose of the pressure dressing, and the displacement of the dressings may seriously distort the shape of the reconstructed ear.Furthermore, once the bandage has slipped it is extremely difficult to reapply a good dressing, especially in a conscious patient.3. An adequately padded pressure dressing may become uncomfortably hot and a child may deliberately loosen the bandages himself to gain relief.Unconsciously during sleep he may also pick at his bandages or dislodge the dressing by friction against the pillow or mattress.