2015.4-26

Did Sushrutha first describe ear lobe repairs? A peep into the Samhita

Harinatha Sreekar1, Ravi Reddy2, Nithya Raghunath3, Nikhitha Raghunath4, Harinatha Sreeharsha5

1Department of General Surgery, MVJ Medical College, Bangalore, Karnataka, India2Department of General Surgery, Vijaynagar Institute of Medical Sciences, Bellary, India3Contura Cosmetic Clinic and Department of Dermatology, MVJ Medical College, Bangalore, Karnataka, India4Department of Community Dentistry, Oxford Dental College, Bangalore, Karnataka, India5Department of Urology, Fortis Hospital, Bangalore, Karnataka, India

Corresponding author: Ass. Prof. Harinatha Sreekar, E-mail: drsreekarh@yahoo.com
Submission: 01.02.2015; Acceptance: 10.07.2015
DOI: 10.7241/ourd.20154.130


Sir,

Ear lobe repairs are among the commonest and simplest procedures performed by plastic surgeons in India. The heavy jewelry that’s part of the Indian tradition surely is the culprit. Given the prevalence of the elongated (or torn) ear lobes in India; it’s only logical that surgeons of yore ventured into remedying this simple issue. Now a days there are many methods of repairing a partial or completely torn ear lobe [1,2]. The techniques have ranged from simple adjustment of local skin to more imaginative sandwiching of conchal cartilage [3]. Who first described the ear lobe repair however is unclear.

Sushrutha, now widely regarded as the ‘father of plastic surgery’ in his treatise ‘Sushrutha Samhita’ seems to describe in fairly elaborate detail the method of repairing a torn ear lobe. He even described over fifteen different procedures based on the nature and size of ear lobe tear. Some include

 

  1. The Nemi- Bandhinaka: To be used in cases where the bifurcated lobes and equal in size.

  2. The Utpala-Bhedyaka: To be used in cases where the severed lobes are round, extended, and equal.

  3. The Valluraka: To be used in cases where the severed lobes of the ears would are short, circular and equal in size.

  4. The Aangima: To be adopted in cases where the anterior surface of the torn lobe is more elongated than the other.

  5. The Ganda-Karna: To be adopted in cases where the posterior surface of the torn lobe is more elongated than the other.

 

Though the exact details of the surgical nuances are difficult to decipher, he does mention some valid and important aspects of lobe repair. He mentions slicing off a patch of healthy skin from the cheeks and adhering it to one of the severed lobes (Akin to a skin graft). He describes a process called the Kapata-Sandhika (closing of the two leaves of a door {Kapatam}) wherein he brings about an adhesion, on the posterior side, between the bifurcated lobes and another, which by shortening the elongated anterior side of the ear (Akin to a wedge excision or a Z-plasty). He also describes the Ardha-Kapata-Sandhika (Ardha{Half} Kapata {Door} Sandhika {Joining}) [4]. This description has a peculiar resemblance to the half Z-plasty. The nature of Sushrutha’s contribution to reconstructive surgery is a matter of controversy which is unlikely to die down in the near future. Part reason for such confusion is the presence of numerous translations and even more numerous interpretations. However, the very fact that he might have described procedures like adhesion, Z-plasty and half Z-plasty is a matter of awe in itself.

REFERENCES

1. Zilinsky I, Tessone A, Winkler E, Mendes D, Liran A, Partially torn ear lobe repair using a cross-stitching techniqueDermatol Surg 2009; 35: 987-9.

2. Reiter D, Alford EL, Torn earlobe: a new approach to management with a review of 68 casesAnn Otol Rhinol Laryngol 1994; 103: 879-84.

3. Agarwal R, Chandra R, A new technique for repair of acquired split-ear-lobe deformity: the free conchal cartilage sandwich graftJ Plast Reconstr Aesthet Surg 2010; 63: 499-505.

4. Kunja Lal, Bhishagratna K, An English translation of the Sushruta samhita, based on original Sanskrit text 1907; Calcutta: JN Bose College Square; 143-7.

Notes

Source of Support: Nil

Conflict of Interest: None declared.


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