LETTER TO THE EDITOR
A useful dressing for ear surgery
Received: 9 July 2007 / Accepted: 20 February 2008 / Published online: 12 April 2008
Plastic surgery of the auricle demands, on occasions, skin
grafting of some of the reconstructed areas. Proper pressure
dressing of the surgically constructed ear, in an attempt to
diminish the shear stress of the grafts over the flaps or the
cartilage framework, becomes mandatory when facing such a
surgical procedure. Loss of grafts, partial or total, might
develop into serious complication, require additional surger-
ies, and cause significant stress for the patient and the family.
This problem has to be addressed more accurately when
performing ear reconstruction in children. The child’s inability
to follow medical recommendations such as maintaining
a resting, adequate position of the head and neck on the
postoperative period makes this matter especially delicate.
The ideal dressing should consist of a resistant, non-
adherent, and extremely adaptable material, which is readily
available in every plastic surgery department. Classically, long
sutures have been used tied over a bolus dressing to safely
stabilize this kind of graft. Although this conventional device
prevents the accumulation of fluids over or under grafts, they
may become nonadherent due to oozing absorption. The same
concept should be applicable to eyelid grafting, although its
surface is less convoluted than ears.
Our experience in the pediatric plastic surgery unit working
with cleft palate patients brought out the opportunity of
finding a product that could satisfy these needs. AQUASIL™
Soft Putty (Dentsply International, PA, USA) is a silicone
impression material used by orthodontists and dentists. It is
currently available at the Cleft Unit at Hospital Universitario
Niño Jesús. By using this easy-to-handle, nonadherent, and
adaptable silicone, we have developed a new dressing that has
been highly satisfactory in our experience.
After positioning the grafts and anchoring them with
various absorbable long sutures, a layer of tulle grass is
placed over the grafted skin. An AQUASIL™ plate is
prepared and molded over the zone, adapting it to every nook
and cranny. The plate hardens in a few minutes and long
sutures are tied firmly fixing the material. A soft bandage is
placed to cover the entire dressing.
Grafts are assessed for take after a week by carefully
removing the silicone plate. Its nonadherence is helpful
while performing this maneuver.
In several other situations, the use of silicone impression
material as a dressing has been of considerable use, and these
are presented. The separation of a surgically constructed ear
from the head with a skin graft (Brent  stage 3, Nagata ,
or Firmin  stage 2), in these cases, the silicone “splint” is
extremely useful in maintaining a proper position of the ear.
In effect, it acts as a cast, keeping the ear abducted and
avoiding the newly constructed posterior auricular crease
from retracting and pulling the ear backwards (Fig 1).
Casting material After the take of the grafts on the separated
ear, to avoid a late retraction of the ear due to scarring, the
use of this material as an abducting mold has proven to be
useful. It is removable, comfortable, and hygienic.
Eur J Plast Surg (2008) 31:91–92
No financial support was received for any portion of this manuscript.
The authors have no financial interest in any commercial device herein
G. Miralles (*)
Servicio de Cirugía Plástica, Estética y Reconstructiva,
4° Planta HRT, Hospital Universitario La Paz,
P° de la Castellana 261,
28046 Madrid, Spain
Plastic Surgery Department, Hospital Universitario Niño Jesús,