This document summarizes Shilpa Bisht's presentation on karna vedhan (ear piercing) and karna sandhan (ear lobe repair) according to Sushruta Samhita. It discusses the 15 types of plastic repair procedures described by Sushruta for correcting various deformities of the ear, focusing on form, function and cosmesis. Key points include the appropriate timing, positioning and techniques for ear piercing and addressing complications. Sushruta provides detailed guidance on suturing techniques, materials, post-operative care and contraindications for successful ear lobe repair.
2. Acharya Dalhana described the term Sandhana as
unions of organs which are separated due to injury or
trauma in his commentary.
Today Sandhan is at its advanced position in the form
of plastic and reconstructive surgery.
3. Acharya Sushurut has explained 15 types of surgical
procedures for the correction of various deformities
revolves around the basic purpose of providing -
a) Form
b) Function
c) Cosmesis
Even today, in contemporary medical science the basic
aim of plastic surgery remains the same. Thats why
modern plastic surgeon gives credit to Sushruta for his
work and accept Sushruta as pioneer of Plastic Surgery
(The Father of Plastic Surgery)
11. SUCCESSFUL METHODS
Type- Nemi-sandanaka
Meaning-Circumference
of a wheel
(round/circular sewing)
Indication- Flaps are
equal -Wide ,Thick
पृथुलायतसमोभयपालल
Type- Utpala
Meaning-bhedyaka Like
lotus bud
Indication- Flaps are
equal -Wide , Round
वृत्तायतसमोभयपालल
12. Type- Valluraka
Meaning-Like dried
meat
Indication- Flaps are
equal-Short, Round
ह्रस्ववृत्तसमोभयपालल
Type- Asangima
Meaning- sewing a big
available portion only in
the non- availability of
small portion at the
same place
Indication- One flap
only –Inner flap long
अभ्यन्तरदीर्घैकपालल
13. Type- Gandakarna
Meaning-front portion of
long outer flap is unified
with taking out the cheek
muscle
Indication-One flap only
–Outer/distal flap long
बाह्यदीर्घैकपालल
Type- Aharya
Meaning-Both sides cheek
muscle with attachment is
taken out and shaping it
like pinna.
Indication- Both the
fragment of cut ear lobules
are absent
अपाललरुभयतो
14. Type- Nirvedhima
Meaning-Unified by
piercing
Indication- when both
the flaps of cut ear lobules
are absent from the root.
In this type remaining part
of Putrika (Tragus) is
making base for surgery.
पीठोपमपाललरुभयताः क्षीणपु
लिकालितो
Type- Vyayojima
Meaning- fabricating the
pinna by different kinds of
cuttings
Indication-One flap is
even(thin/thick) other
uneven
स्थूलाणुसमलवषमपालल
15. Type- Kapata-sandhika
Meaning- Externally
unified like panels of a
door
Indication- long Inner
flap, short outer flap
अभ्यन्तरदीर्घैकपाललरिरतरा
ल्पपाललाः
Type-Ardha-kapata-
sandhika
Meaning-Internally
unified like half- panel
Indication- long outer
flap, short inner flap
बाह्यदीर्घैकपाललरिरतराल्पपा
लल
16. Type- Sankshipta
Meaning- Small
Remnant
Indication- Dried up
pinna, one flap raised
other one short
Degenerative condition
of pinna
ति शुष्कशष्क
ु ललरुत्सन्नपा
ललरिरतराल्पपाललाः
Type- Hinakarna
Meaning- Insufficient
Indication- Flaps
without base, atrophy of
muscles
अनलिष्ठानपाललाः पययन्तयोाः
क्षीणमाांसो
Unsuccessful methods
17. Type- Vallikarna
Meaning- Creeping or
winding
Indication- Flaps thin,
uneven ,short
Microtia with preauricular
appandages and skin tag
तनुलवषमाल्पपालल
Type- Yashtikarna
Meaning- Resembles like
a stick
Indication-Flaps small,
full of knotty muscles and
stiffened vessels.
Pinna and lobule have
keloids and atrophied
ग्रलथतमाांसस्तब्धलसराततसूक्ष्म
पालल
18. Type- काकौष्ठक
Meaning- Shaped like the beak of a
crow
Indication-Flaps are emaciated with
shortened tip and less vascular
Microtia
लनमाांससलिप्ताग्राल्पशोलणतपाललाः
19. Correct method of Repair for Torn
Ear Lobule
बाह्यायानिह दीर्ाणयां सन्धन्धराभ्यन्तरो भिेत् |
आभ्यन्तरायां दीर्ाणयां बाह्यसन्धघर्रुदाहृताः ||(Su.Su.16/14)
When damage is great internally (medially) suturing
should be done externally (posteriorly).
When damage is great externally (posteriorly)
suturing should be done internally (medially).
20. एक
ै ि तु भिेत् पानलाः स्थूला पृथ्वी न्धस्थरा च या |
तां नििा पाटनयत्वा तु नित्त्वा चोपरर सन्धयेत् ||(Su.Su.16/15)
If there is only one flap split ear lobule and if it is
thick, wide and fixed, then it should be divided,
trimmed and joined with upper portion. The plastic
surgeons now-a-days following this technique and
named it as Y-V Repair.
21. ततो व्रणं सिुन्नम्य स्थापनयत्वा यथान्धस्थति् |
सीर्व्ेत् सूक्ष्मेण सूत्रेण िल्क
े िाश्मन्तकस्य िा || (Su.Su.25/20)
The edge of the wound should be raised, both the flaps
should be brought in to opposition, then Suturing
should be done by a fine thread.
Now instead thread of Ashmantaka,murva
guduchi we have used Nylon 6-0, for suturing.
22. Graft
गण्डादुत्पाट्य िांसेि सािुबन्धेि िीिता |
कणणपालीिपालेस्तु क
ु याणनन्ननलणख्य शास्त्रनित् || (Su.Su.16/16)
Cutting out a flap of the living musles from the cheek
retaining its connection intact, turning it over to the
side of the lobe after scrapping the area. Thus, making
up the lobe.
23. Procedure of karna sandhan
Knot hair
properly and
give light food
Chhedan
Examination
of blood
When
bleeding stop
suture ear lobe
Apply Madhu
and Ghrit
Put dressing
not too tight
not too loose
24. आितैलेि नत्ररात्रं पररषेचयेत्, नत्ररात्राच्च नपचुं पररितणयेत् |
3 days with
uncooked oil
bathed
on 3rd day
dressing
change
elongate the
slit by means
of Bardhanaka
(Dilator)
Otherwise
Complications
28. Contraindication for operation
ि चाशुद्धरक्तिनतप्रिृत्तरक्तं क्षीणरक्तं िा सन्दध्यात् |(Su.Su.16/19)
When blood found to be vitiated
Excessive bleeding
Very less bleeding
30. Continued…..
If blood is contaminated there will be infection.
Atipravrtha raktha as excessive blood flow lead to
haematoma formation following suturing and will
became a potential source of infection.
Ksheena rakta can be considered in two senses i. e.
decreased total blood volume of the patient and
decreased blood flow to the grafting site. In both cases
the procedure will not be successful.
31. Abstinence
निर्ट्टिं नदिास्वप्नं र्व्ायाििनतभोििि् |
र्व्िायिनिसन्तापं िाक्श्रिं च निििणयेत् || (Su.Su.16/18)
Rubbing of ear
Day sleep
Exercise
Excessive eating
Copulation
Fire and sunlight exposure
Excessive talking
32. Indication –when do karna vardhan
िातरोिा सुिर्त्ाण च न्धश्लिसन्धन्धाः सिाः न्धस्थराः |
सुरूढोऽिेदिो यश्च तं कणं ििणयेच्छिैाः ||२५|
After bandh if –
Hairs have developed
Looks good ie. Healed properly
Joint is well adhered
Skin on both side of suture line is even and stable
Well healed
Painless
33. बद्धिात्रं तु याः कणं सहसैिानभििणयेत् |
आिकोशी सिाध्माताः नक्षप्रिेि नििुच्यते ||२४||
If the ear lobe which has just healed is suddenly made
to grow then it becomes swollen and breaks off
quickly.
34. अनितााः कणणबन्धास्तु निज्ञेयााः क
ु शलैररह |
यो यथा सुनिनशिाः स्यात्तं तथा निनियोियेत् |(Su.Su.16/26)
Method of joining mutilated ear are innumerable and
should be learnt from expert, that which is appropriate
at the moment should be decided and undertaken.
35. • It is a surgical procedures for
reconstructing a defective,
deformed, or absent external ear,
consequent to trauma or
congenital anomalies e.g.
microtia, anotia etc.
Otoplasty
• It is the surgical procedure
prescribed to repair a split or
torn earlobe.
Lobuloplasty
36. •Auricular lobuloplasty is an easy surgical procedure and has a
low risk of complication with very satisfactory results; therefore,
it should be recommended for patients with lobular deformities.
•Most common procedures done in outpatient basis.
•Inspite of the innumerous techniques used,the ultimate aim of
the surgery is to obtain a soft supple lobule with a well-hidden
cosmetic scar without the complication of recurrence.
37. Deformities acquired in the ear lobe through the use of
piercings, extenders, trauma, surgery, or aging are
much more frequent than congenital ones, observed in
1:1500 births.
40. Cleft corrections
With preserving the earring orifice.
Without preserving the earring orifice when a
new orifice can be made after three-six
months of healing.
Divided into two large groups
41. Several techniques for reducing and correcting the earlobe
McLaren- first described repair of partial earlobe clefts using a
simple linear closure by de-epithelializing the partial cleft scar
with a scalpel and closing the margins in a straight-lineslight
scarring of the gap edges and simple suturing of the margins.
Miller-simple wedge excision to reduce the earlobe
Boo-chai- proposed the excision of part of the cleft edges and
suture below the original orifice
Kalimuthu et al. - “V” flap technique, in which a “V” incision
was made at the end of the lobe, followed by de-epidermization
at the medial edge, and another “V” incision at the end of the
lateral edge to fit after the suture.
Fatah and Fearon & Cuadros - presented the “L” flap technique
42. Procedure for simple repair
Cleaning and painting the ear lobe
Infiltration of local anesthesis into lobule
Excise the scar all around with surgical blade
Sutured in the anterior and posterior aspect
separately.
Apply pressure bandage and dressing
46. Deppressed suture line
•Scar tissue that resides in the
neighboring area of the enlarged
hole that was not completely
excised during lobuloplasty.
•Add step of scoring each
lobular segment into two layers
after excising the scar tissue with
a no 11 surgical blade so as to
incise the scar that adheres the
anterior and posterior layers of
the lobule.
47. Scoring of the scar,
to form anterior (A) layer
and posterior (B) layer
Scoring with undermining of scar
tissue with NO 11 blade
48. For recurrent enlarged holes and
in very old patient additional
cartilage piece is added
horizontally in the inferior aspect
of the previous hole.
The convex surface of the cartilage
(harvested from the auricle) is
placed anteriorly.
This prevent the dragging pull
over the scar in the future.
49. Infiltration of LA
To prevent multiple pricks
in the lobule to achieve
anesthesia,
Single prick in the skin fold
that attaches the lobule to
the face can be given.
At this site the nerve
supplying the whole of the
lobule can be anaesthetized
instantly with a single
prick.
50. Utility of Laser in Lobuloplasty
Skin incision by surgical blade causes bleeding which
obscures the field and reduces precision. Control of
bleeding is cumbersome for the surgeon because of
the small size of lobule, lack of support and firmness.
Diode laser of the frequency of 2.5 W and a wavelength
of 850 nm used for skin incision instead of surgical
blade.
51. Advantages
Diode laser for skin incision-Sharp cutting edge
allowing precise cut
Better coagulation
Instant sterilisation reduces bacterial load
Less operative and anaesthesia time
Minimum discomfort to surgeon and assistant
Better healing
Less scarring
52. Using a tissue adhesive
•A: Excision of cleft edges;
•B: Displacement of the skin edge;
•C: Intradermal suturing and start of
adhesive bonding ( cyanoacrylates)
• D: Adhesive-bonded earlobe and
exposed dressing.
53. Schematic illustration of the adapted "L"
technique
1. Lobe with partial cleft and
vertical elongation.
2. Triangular incision around the
defect.
3. Removal of a small rectangular
fragment from the proximal half of
the defect.
4 and 5. Distal half pulled up and
forward.
6. After suturing and correction of
the defect resulting in shortening
of the lobe
57. A surgical incision line was drawn with a marking pen
Flap is designed to transfer
skin from an area of
relative excess to fill a
neighbouring defect.
58. “V” shaped tissue is then advanced
to cover the defect.
Infected part is excised
59. Donor site is sutured in a straight line
which creates a “Y” shaped closure.
Postoperative result at 6 month follow-up
60. Hypertrophic scar
Depressed scar
Wide scars
Recurrence of the cleft
Surgical wound infections