Use of Cultured Human Keratinocytes for the Management of a Complex Traumatic Auricular Wound
Main Article Content
Abstract
Introduction: Complex traumatic injuries of the external ear that cause devitalization with exposed cartilage which requires advanced treatment, as they can lead to both acute infectious complications and late problems related to deformity. Management of these cases usually requires reconstruction; however, conservative treatment is an option that may preserve function and restore the anterior and lateral contours without increasing risks or complications.
Objective: Present a clinical case describing a novel application of cultured human keratinocytes for the management of a complex auricular wound.
Methods: The clinical case of an 11-year-old female patient is presented. She sustained polytrauma with partial loss of the left auricle, 2 x 1.4 cm of exposed cartilage, and loss of skin continuity of the helix. Primary closure was performed, and keratinocytes were manually collected from the Epifast sheet and applied to the raw wound and exposed area. The aim is to present the procedure and its results in order to disseminate another management option that does not involve surgery.
Results: Findings 2 weeks after the first application of Epifast showed cartilaginous exposure measuring 5 mm in diameter, so Epifast was applied again, achieving complete epithelialization of the exposed auricular cartilage at 5 weeks. At 6 months, epidermal thickening with good scar quality was observed; no complications occurred during follow-up.
Conclusion: Application of keratinocytes promotes granulation tissue formation and re-epithelialization by secreting cytokines that modulate cell proliferation, migration, and differentiation during healing of ear wounds with exposed cartilage.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Steffen A, Frenzel H. Trauma management of the auricle. Facial Plast Surg. 2015;31(4):382–5.
II. Turpin IM, Altman DI, Cruz HG, Achauer BM. Salvage of the severely injured ear. Ann Plast Surg. 1988;21(2):170–9.
III. Habiba NU, Khan AH, Khurram MF, Khan MK. Treatment options for partial auricle reconstruction: a prospective study of outcomes and patient satisfaction. J Wound Car. 2018;27(9):564–72.
IV. Lavasani L, Leventhal D, Constantinides M, Krein H. Management of acute soft tissue injury to the auricle. Facial Plast Surg. 2010;26(6):445–50.
V. Gutiérrez GC, Pradel MJJ, Pierdant LR, Lorenzana SC. Estudio epidemiológico del trauma de pabellón auricular en el Hospital General Dr. Manuel Gea González, México. Cir. plást. iberolatinoam. 2018; 44( 3 ): 287-295.
VI. Thill M-P, Horoi M, Ostermann K, Depuydt C, Deschamps M, Ducène C. Acute external ear lesions: clinical aspects, assessment and management. B-ENT. 2016;Suppl 26(1):155–71.
VII. Goel TK, Law EJ, MacMillan BG. Management of the acutely burned ear. Burns. 1983;9(3):218–23.
VIII. Toft-Nielsen C, Lyneborg N. External ear traumas and their complications. Ugeskr Laeger. 2019;181(46).
IX. Saito T, Yotsuyanagi T, Ezoe K, Ikeda K, Yamauchi M, Arai K, et al. The acute surgical management of injury to the helix and antihelix in patients with large body surface area burns. J Plast Reconstr Aesthet Surg. 2009;62(8):1020–4.
X. Domínguez-Saavedra G, Hernández-Galván JM. Actualización en el manejo de heridas. Cirugía Plástica. 2021;31(3):124–36.
XI. Arenas GCM, Merizalde SGJ, Restrepo MLM. Sustitutos cutáneos desarrollados por ingeniería de tejidos. Iatreia. 2012 Jan; 25 (1): 5-11.
XII. Mares MRC, Álvarez TLP, Rosales PJF, et al. Uso de aloinjerto epidérmico cultivado en quemaduras faciales en adultos. Cir Plast. 2016;26(3):112-118.
XIII. Caputo G, Monese C, Governa M, Barisoni D. Letter to the editor: conservative treatment in auricle burns. Ann Burns Fire Disasters. 2005;18(4):217–8.
XIV. Purdue GF, Hunt JL. Chondritis of the burned ear: a preventable complication. Am J Surg. 1986;152(3):257–9.