Case report A near closed book contracture of the ear: a case report Hemant A. Saraiya a, b, * a Sushruta Plastic Surgery Research Center, Ahmedabad, India b The Mehsana District Co. Op. Bank Ltd General Hospital, Mehsana, India Accepted 10 September 1999 Abstract An unusual post-burn ear contracture, involving crus helicis, cymba conchae, tragus and antihelix, with anterior vertical folding of the ear on itself, like a closed book, has been described. The contracture was completely released and the resultant raw area was covered by a full thickness skin graft, harvested from the opposite post-auricular area. The crippled ear cartilage was still folded anteriorly at the level of the concha, regardless of complete release, due to long standing childhood burns. Three months later, concha-mastoid suturing was carried out to give the ear its normal shape and erect, prominent position. Four years of follow up showed, an aesthetically good-looking ear with satisfactory position. 7 2000 Elsevier Science Ltd and ISBI. All rights reserved. Keywords: Ear contracture; Post-burn deformity; Concha-mastoid suturing 1. Introduction Human ears are remarkable for their individuality but at the same time, their exposed position make them more vulnerable to any external assault. Isolated burns of the ear though very uncommon, usually results from either direct thermal or chemical contact injury. The thin and tightly adherent anterior skin is easily damaged, resulting in cartilage exposure, desic- cation and infection. Depending on the location and extent of the injury, the ear may heal with either a localised and minor deformity or a severe deformity of this kind requiring late reconstruction. This case high- lights the sequel of the improperly treated burn injury. Scanty information about this type of contracture in the literature compelled us to conceive a two-staged method, utilising all the basic plastic surgery prin- ciples. 2. Case report A 17-year-old girl presented with an unusual con- tracture of the ear. She gave a history of hot oil burns as a child. Dressings were carried out for nearly 2 months by her family physician, until complete healing was achieved. On examination she was found to have a ®rm tethering between crus helicis, cymba conchae, tragus and antihelix, leading to vertical folding of the ear like a closed book. The external ear canal could not be seen due to lidding by the folded ear. Attenu- ation with distortion of the cartilage was also found. The contracture was released completely and a full thickness skin graft from other post-auricular area was used to cover the raw area. There was some patchy super®cial loss of the full thickness graft because of poor underlying vascularity. The area became epithe- lialised in a few days, not aecting the contracting pro- Burns 26 (2000) 490±492 0305-4179/00/$20.00 7 2000 Elsevier Science Ltd and ISBI. All rights reserved. PII: S0305-4179(99)00179-5 www.elsevier.com/locate/burns * 10, Avanti Apartments, Bhagvan Nagar No Tekro, Paldi, Ahme- dabad 380 007, India. Tel.: +91-79-657-6170; fax: +91-79-643-0501. E-mail address: drhemantsaraiya@hotmail.com (H.A. Saraiya).