Comparison of otoplasty outcomes using different types of suture materials

Prominent ears are the most common congenital deformity. Numerous techniques for the correction of this deformity have been described in the literature, but there is no single technique widely accepted by most surgeons. Usually, more attention is focused on sculpturing or suturing techniques but not on suture material. The aim of this study is to evaluate clinical outcomes after otoplasty for surgical correction of prominent ears with different suture materials for the formation of new antihelical fold. During a 3-year period (2006-2008), 133 patients underwent operative correction of protruding ears in a private plastic surgery center. A total of 100 patients came for the follow-up visits, and the data of these patients were included in further analysis. The surgical technique consisted of scoring of the antihelical cartilage, suturing to recreate the fold of the antihelix (in the manner of Nachlas), and conchal setback procedure according to Furnas technique. According to suture material used for formation of new antihelix fold, the patients were divided into three groups: 4/0 Monocryl group (35 patients, 70 ears; Group 1), 4/0 PDS group (27 patients, 54 ears; Group 2), and 4/0 Mersilene group (38 patients, 7 ears; Group 3). Distances from the temporomastoid surface of the skull to the helix border in the upper, middle, and lower parts of the ear were measured before surgery and 6 months following surgery, and these measures were compared among groups. In addition, early and late complications were analyzed. There were 48 men and 52 women, and the median age was 20 years. The groups were matched for age, sex, and protrusion degree. No statistically significant differences were found comparing the groups of different suture material by skull-helical rim distance before operation. Comparison of skull-helical rim distance among groups after surgery showed that this distance in the medial and lower parts of the ear was the same in all groups, but this distance was smaller in the upper part of the ear in the Mersilene group; however, this difference was not statistically significant. Three patients in the Monocryl group (6 ears, 8.57%) and 3 patients in the PDS group (6 ears, 11.11%) had unsatisfactory aesthetic outcome because of recurrence of protrusion in the upper part of the ear. All of them underwent reoperation. In the Mersilene group, no recurrence was documented, but suture extrusion occurred in one patient (2 ears, 2.63%), and the sutures were removed. In our experience, formation of new antihelical fold with a 4/0 Mersilene suture resulted in the lowest rates of late complications. Using this type of suture material, some suture extrusions occurred, but this problem was easily solved by removing sutures. No recurrences of protrusion were documented in this group; therefore, no revision surgeries were necessary.