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INCREASED INFECTION IN TOTAL EAR RECONSTRUCTION PATIENTS WITH PATENT EXTERNAL AUDITORY CANAL WARRANTS A PERIOPERATIVE TREATMENT PROTOCOL
Presenter: Andrew Vardanian, MD
Co-Authors: Tong A; Lee JC; Federico C; Bradley JP
UCLA

Background: Total ear reconstruction for microtia is one of the most challenging procedures for a plastic surgeon and infection of a cartilage graft can jeopardize an outcome. After treating an ear reconstruction case with a patent external auditory canal (EAC) for infection we 1) compared the incidence of infection with total ear reconstruction (no EAC vs. patent EAC) 2) determined if a protocol designed for reducing bacteria with a patent EAC helped reduce 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 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). Patient/physician outcome surveys (scored on a 0-4 scale) were 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. More superficial and deep infections (29% vs. 12%), cartilage exposure (31% vs. 9%), surgical debridement (27% vs. 8%) and loss of graft (7% vs. 1%) were observed in patients with patent EAC versus none. Swabs from EAC showed Staph Aureus and various atypical bacteria. Protocol to sterilize 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 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 is warranted.


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