Don't amputate that ear! Reconstructive surgical options for defects of the pinna in dogs

Not all veterinarians are aware of the reconstructive surgical options available for defects of the pinna secondary to trauma and tumor resection in dogs. In a number of cases, amputation of the pinna can be avoided.

Michael Pavletic, DVM, DACVS

The reconstructive surgical options for managing pinnal defects depends on

• The size of the lesion

• The lesion's location on the pinna

• The anatomic conformation based on the breed and species.

In cases in which extensive neoplasia extends into the terminal pinna, complete amputation of the pinna is usually indicated. And from a practical standpoint, amputating the terminal third of the pinna is a realistic option because of the intimate relationship between the pinnal cartilage and the overlying skin surfaces.

However, the lower two-thirds of the pinna has a different anatomic configuration to the terminal ear region. The outer pinnal skin reflecting off the dorsum of the head is mobile and comparatively free of the pinnal cartilage attachment. The skin then transitions into a progressively closer association with the cartilage as it ascends to the terminal third of the pinna. This permits the surgeon to consider simple skin flap options for closure of defects in the lower half of the ear, both on the inner and outer aspects of the pinna. Distance, however, is relative to the length of the ear. For example, short ears on a dog may allow a skin flap to extend to the tip of the pinna. In longhaired breeds, excessive hair can be trimmed around the external auditory opening if necessary.

Transposition flaps are the most effective local flap option to close surgical defects after removal of the diseased skin and underlying cartilage layer (see Closing a pinnal defect with a transposition flap). Simple skin advancement may suffice for lower pinnal defects involving the base of the ear. The available skin around the base of the ear and in the vertical ear canal makes these regions ideal donor sites for pedicle graft development.

Transposition flaps can also be used to cover large areas of denuded pinna secondary to trauma. With extensive skin loss involving the outer pinnal surface, I have used the caudal auricular axial pattern flap to resurface the entire outer pinnal surface.

Dr. Pavletic is director of surgery at Angell Medical Center. For more information about reconstructive surgical options, or if you have any questions regarding any challenging cases, Dr. Pavletic welcomes your inquiries. You can reach him by calling 617-541-5048 or e-mailing mpavletic@angell.org. For information about Angell's Surgery service, please visit angell.org/surgery.