Pressure Earring as an Adjunct to Surgical Removal of

HOW WE DO IT
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Earlobe Kctrsids
Yrcar SavIoN, DMD, Monorcu.u SEle, DMD,
-q.Nn
ANer SuanoN-But-lEn, DMD*
The authors have indicated no significant interest with commercial supporters.
T7 eloid formation is a known complication of
.N.."rlob. piercing,l causing discomfort and
disfigurement (Figure 1). Surgical excision of the
lesion as a sole treatment modality results in a high
recurrence rate of 45"/. to 100"/".2 A variety of
concomitant treatments are used to improve the
success rate, such as steroid injections,3 localized
irradiation,a cryosurgery,s topical application of
immune response modifiers,6'7 and long-term
pressure application using pressure earrings,
The classic method of fabricating a pressure earring
involves making an impression of the auricle after
initial healing from surgery, pouring it in hard stone,
and making the device on the cast from acrylic resin.
Our technique allows prefabrication of pressure
earrings in a variety of sizes to fit different earlobes
without making impressions and without being
dependent on the availability of trained technicians.
magnets, or bandages.l'2
The device consists of two 3-mm-thick plates of clear
Perspex attached using two plastic screws (Figure 2).
Pressure causes localized hypoxia, resulting in
To fit keloids of different sizes, the plates are made in
three sizes (4.0 x2.0cm,3.7 x 1.7cm, and
fibroblast degeneration and disintegration.8 It is
also claimed to shorten scar formation time, increase
collagenase activity, reorient collagen fibers to
become parallel to the skin surface, increase
hyaluronic acid levels, and decrease chondroitin
sulfate levels,e all of which are associated with
reduction in recurrence.
Pressure earrings are widely used as an adjunct to
4.3 x2.3cm). The earring, which should cover
the area from which the keloid was removed, is
placed over the earlobe, and the screws are tightened
(Figures 3 and 4). 'We recommend tightening
the screws until initial blanching appears, as an
indication of reduced blood perfusion (indicating
hypoxia of the tissue, which is paramount in
preventing keloid recurrence).
surgery in the treatment of earlobe keloids.l'2'8-13
Their construction should adhere to the following
guidelines:13 strong) noninflammable, lightweight,
comfortable, easily applied and removed by the
patient, providing uniform pressure over the tissue,
not compromising hearing, being esthetically
acceptable, allowing for proper hygiene, and being
easy
to fabricate and inexpensive.
*All authors
The patient is instructed how to remove, insert,
and clean the appliance and scheduled for periodic
follow-ups at 2-week intervals thereafter. \7e
recommend continuous use of the appliance for
6 months. This method has been in use in our
hospital for the last 10 years, yielding a recurrence
'We
find patient's
rate of approximately 20%.
are affiliated witb the Department of Maxillofacial Prosthetics, Hadassah Hospital, Jerusalem, Israel
@ 2009 by tbe American Society for Dermatologic Surgery, Inc. c Published by Vtiley Periodicals, Inc. c
ISSN: 1075-05'12 o Dermatol Surg 2009;35:490192 . DOI: 10.1111/i.1524-472-t.2009.01071.x
t\ : - !i
tgure
1. Keloid of the earlobe.
Figure3. Pressure earring in place. Iateral view.
adherence to be good. Because the appliance is small
and made of clear Perspex, they wear it comfortably
rn public and report no difficulties in wearing
Juring
it
sleep.
is easily controlled using the incorporated screws,
avoiding discomfort and possible necrosis of rhe
tissue due to excessive pressure. The earring is
relatively inconspicuous.
There are several advantages of the proposed technique. It is simple and easy to fabricate. Preparation
of the pressure earring before surgery allows pressure
application immediately after stitch removal, without having to wait for further healing. Dependence
on the availability of a maxillofacial prosthodontist
to make an impression and fabricate the device is
circumvented. The pressure exerted by the appliance
Figure2. The completed pressure earring.
Figure4. Pressure earring in place, posterior view.
3.5:3:MARCH 2009
PRESSL]RE EARRING AS AN ADJUNCT TO SURGICAL REMOVAL OF EARLOBE KELOIDS
The disadvantage of the technique is that it can be
used to treat earlobes only. Other parts of the auricle
are not as flexible and, therefore, cannot be pressed
between two flat rigid surfaces. For those areas, the
traditional method of a custom-made device must
5. Fikrle I Pizinger K. Cryosurgery in the treatmenr of
be used.
7. Martin-Garcia RI,
It should
earlobe
keloids: report of seven cases. Dermatol Surg 2005;31:
1.728-i1.
6. Stashower ME.
Successful treatment of earlobe keloids with
imiquimod after tangential shave excision. Dermatol Surg
2006;32:380-6.
Busquets AC. Postsurgical use of imiquimod
57o cream in the prevention of earlobe keloid recurrences:
results of an open-label, pilot study. Dermatol Surg 2005;31:
be emphasized that the literature lacks
consistent guidelines to the following questions.
How soon after surgery should pressure earrings
'S7hat
be used?
should be the duration of their use?
How many hours daily should they be worn? How
much pressure should be applied? \fell-controlled
strsdresrre-\ssgssrr5(sstsssler.,s,g\Ktst-qsts\isrrs.
1394-8.
8. Vachiramon A, Bamber MA. A UJoop pressure clip for earlobe
keloid.
I
Prosthet Dent 2004;92:389-91.
9. Akoz ! Gideroglu K, Akan M. Combination of different
tech-
niques for the treatment of earlobe keloids. Aesthet Plast Surg
2002.26:1,84-8.
10. Yencha
MIf,
:\\\r$$
Oberman JP. Combined therapy in the treatment of
\b\S$\.
\rr Nsse\\torr ) )\\t$S $}J
.
11. Hurtado AI, Crowther DS. Methyl methacrylate srenr for
prevention of postexcisional recurrent ear keloid. J Prosthet Dent
1985;54:245-50.
References
1. Sela M, Taicher
S. Prosthetic rrearment
of earlobe keloids.
J Prosthet Dent 1984'52:417-8.
2. Chang CH,
J!
Park JH, Seo SS7. The efficacy of magnetic
disks for the treatment of earlobe hypertrophic scar. Ann Plast
Surg 2005;54:566*9.
Song
3. Lawrence WT. Treatment of earlobe keloids with surgery
492
Ragoowans:i R, Cornes PG, Moss
AL, Glees JP. Treatment of
keloids by surgical excision and immediate postoperative singlefraction radiotherapy. Piast Reconsrr Surg 2003;1 1 1: 1 853-9.
DERMATOLOGIC SURGERY
13. Chalian VA, Bennett JE, Syoc AM, Ghalichebaf M. Auricular
compression stent.
I
Prosthet Dent 198.5;.54:560-3.
plus
adjuvant intralesional verapamil and pressure earrings. Ann plast
Svg 1,996;37:L67-9.
4.
12. Pierce HE. Postsurgical acrylic ear splints for keloids. J Dermatol
Surg Oncol 1986;12:583-5.
Address correspondence and reprint requests to: Yigal
Savion, DMD, Deparrment of Maxillofacial Prosthetics,
Hadassah Hospital, Ein-Karem, Jerusalem 91.120, lsrael,
or e-mail: [email protected]