This document summarizes Shilpa Bisht's presentation on karna vedhan (ear piercing) and karna sandhan (ear lobe repair) according to Sushruta Samhita. It discusses the 15 types of plastic repair procedures described by Sushruta for correcting various deformities of the ear, focusing on form, function and cosmesis. Key points include the appropriate timing, positioning and techniques for ear piercing and addressing complications. Sushruta provides detailed guidance on suturing techniques, materials, post-operative care and contraindications for successful ear lobe repair.

1. PRESENTED BY: Shilpa Bisht
PG SCHOLAR : 2nd Year
Shalya Tantra Department

2.  Acharya Dalhana described the term Sandhana as
unions of organs which are separated due to injury or
trauma in his commentary.
 Today Sandhan is at its advanced position in the form
of plastic and reconstructive surgery.

3.  Acharya Sushurut has explained 15 types of surgical
procedures for the correction of various deformities
revolves around the basic purpose of providing -
a) Form
b) Function
c) Cosmesis
 Even today, in contemporary medical science the basic
aim of plastic surgery remains the same. Thats why
modern plastic surgeon gives credit to Sushruta for his
work and accept Sushruta as pioneer of Plastic Surgery
(The Father of Plastic Surgery)

4. रक्षाभूषणनिनित्तं बालस्य कणौ निध्येते |
Protection
Ornaments

5. KARNA VEDHAN –WHEN AND
WHERE ?????
WHEN
• Shashte or saptami masa, on the
auspicious constelation day of
shukla paksha
WHERE
• On devkratya chidra

6. Depending on
the type of pali
If thin -
Suci
If thick-
Ara
Based on sex
of child
Female –
Left ear
Male-
Right ear
Pichu varti should be introduce

7. HOW TO DIAGNOSE ??
Incorrect
Position
Severe
Bleeding
Excessive
Pain
Correct
POSITION
No
Bleeding
No Pain

8. Three siras present over ear lobes
• Fever, Burning sensation, Swelling, Pain
Kalika
• Neck rigidity, Convulsions, Catchy pain of head, Ear
pain
Lohitika
• Pain, Fever, swelling
Marmaika

9. Samyak
vedhan
Aam tail
parisechan
Trihattrihat
sthol varti
Again aam
tail parisechan
Karna chidyate
dwidha
1)Doshas
2)Trauma
Karna sandhan

10. पञ्चदशकणणबन्धनिकल्ााः
15 Patterns of plastic repair
साध्या असाध्यााः
िेनिसन्धािक सनिप्त
उत्पलभेद्यक हीिकणण
िल्लूरक िल्लीकणण
आसनििो यनिकणण
गण्डकणण काकौष्ठक
आहायो
नििेनििो
र्व्ाणयोनिि
कपाटसन्धन्धक
अिणकपाटसन्धन्धक

11. SUCCESSFUL METHODS
 Type- Nemi-sandanaka
 Meaning-Circumference
of a wheel
(round/circular sewing)
 Indication- Flaps are
equal -Wide ,Thick
पृथुलायतसमोभयपालल
 Type- Utpala
 Meaning-bhedyaka Like
lotus bud
 Indication- Flaps are
equal -Wide , Round
 वृत्तायतसमोभयपालल

12.  Type- Valluraka
 Meaning-Like dried
meat
 Indication- Flaps are
equal-Short, Round
 ह्रस्ववृत्तसमोभयपालल
 Type- Asangima
 Meaning- sewing a big
available portion only in
the non- availability of
small portion at the
same place
 Indication- One flap
only –Inner flap long
 अभ्यन्तरदीर्घैकपालल

13.  Type- Gandakarna
 Meaning-front portion of
long outer flap is unified
with taking out the cheek
muscle
 Indication-One flap only
–Outer/distal flap long
 बाह्यदीर्घैकपालल
 Type- Aharya
 Meaning-Both sides cheek
muscle with attachment is
taken out and shaping it
like pinna.
 Indication- Both the
fragment of cut ear lobules
are absent
 अपाललरुभयतो

14.  Type- Nirvedhima
 Meaning-Unified by
piercing
 Indication- when both
the flaps of cut ear lobules
are absent from the root.
In this type remaining part
of Putrika (Tragus) is
making base for surgery.
 पीठोपमपाललरुभयताः क्षीणपु
लिकालितो
 Type- Vyayojima
 Meaning- fabricating the
pinna by different kinds of
cuttings
 Indication-One flap is
even(thin/thick) other
uneven
 स्थूलाणुसमलवषमपालल

15.  Type- Kapata-sandhika
 Meaning- Externally
unified like panels of a
door
 Indication- long Inner
flap, short outer flap
 अभ्यन्तरदीर्घैकपाललरिरतरा
ल्पपाललाः
 Type-Ardha-kapata-
sandhika
 Meaning-Internally
unified like half- panel
 Indication- long outer
flap, short inner flap
 बाह्यदीर्घैकपाललरिरतराल्पपा
लल

16.  Type- Sankshipta
 Meaning- Small
Remnant
 Indication- Dried up
pinna, one flap raised
other one short
 Degenerative condition
of pinna
 ति शुष्कशष्क
ु ललरुत्सन्नपा
ललरिरतराल्पपाललाः
 Type- Hinakarna
 Meaning- Insufficient
 Indication- Flaps
without base, atrophy of
muscles
 अनलिष्ठानपाललाः पययन्तयोाः
क्षीणमाांसो
Unsuccessful methods

17.  Type- Vallikarna
 Meaning- Creeping or
winding
 Indication- Flaps thin,
uneven ,short
 Microtia with preauricular
appandages and skin tag
 तनुलवषमाल्पपालल
 Type- Yashtikarna
 Meaning- Resembles like
a stick
 Indication-Flaps small,
full of knotty muscles and
stiffened vessels.
Pinna and lobule have
keloids and atrophied
 ग्रलथतमाांसस्तब्धलसराततसूक्ष्म
पालल

18.  Type- काकौष्ठक
 Meaning- Shaped like the beak of a
crow
 Indication-Flaps are emaciated with
shortened tip and less vascular
Microtia
 लनमाांससलिप्ताग्राल्पशोलणतपाललाः

19. Correct method of Repair for Torn
Ear Lobule
बाह्यायानिह दीर्ाणयां सन्धन्धराभ्यन्तरो भिेत् |
आभ्यन्तरायां दीर्ाणयां बाह्यसन्धघर्रुदाहृताः ||(Su.Su.16/14)
 When damage is great internally (medially) suturing
should be done externally (posteriorly).
 When damage is great externally (posteriorly)
suturing should be done internally (medially).

20. एक
ै ि तु भिेत् पानलाः स्थूला पृथ्वी न्धस्थरा च या |
तां नििा पाटनयत्वा तु नित्त्वा चोपरर सन्धयेत् ||(Su.Su.16/15)
 If there is only one flap split ear lobule and if it is
thick, wide and fixed, then it should be divided,
trimmed and joined with upper portion. The plastic
surgeons now-a-days following this technique and
named it as Y-V Repair.

21. ततो व्रणं सिुन्नम्य स्थापनयत्वा यथान्धस्थति् |
सीर्व्ेत् सूक्ष्मेण सूत्रेण िल्क
े िाश्मन्तकस्य िा || (Su.Su.25/20)
 The edge of the wound should be raised, both the flaps
should be brought in to opposition, then Suturing
should be done by a fine thread.
 Now instead thread of Ashmantaka,murva
guduchi we have used Nylon 6-0, for suturing.

22. Graft
गण्डादुत्पाट्य िांसेि सािुबन्धेि िीिता |
कणणपालीिपालेस्तु क
ु याणनन्ननलणख्य शास्त्रनित् || (Su.Su.16/16)
 Cutting out a flap of the living musles from the cheek
retaining its connection intact, turning it over to the
side of the lobe after scrapping the area. Thus, making
up the lobe.

23. Procedure of karna sandhan
Knot hair
properly and
give light food
Chhedan
Examination
of blood
When
bleeding stop
suture ear lobe
Apply Madhu
and Ghrit
Put dressing
not too tight
not too loose

24. आितैलेि नत्ररात्रं पररषेचयेत्, नत्ररात्राच्च नपचुं पररितणयेत् |
3 days with
uncooked oil
bathed
on 3rd day
dressing
change
elongate the
slit by means
of Bardhanaka
(Dilator)
Otherwise
Complications

25. Complications
Pain
Inflammation
Burning
sensations
Ear lobule
again may split
in to two parts
Suppuration
Redness

26. Continued….
Swedan of ear
Snehana by
medicated oil
Yava,
Ashwagandha,Til
Uptan
Abhyang with
Medicated oil
Apang desh
prachhan

27. DOSH PRAKSHEP
Vata Ushnodak , Dhanyamla
Pitta Sheetodak , Milk
Kapha Ushnodak , Suramand

28. Contraindication for operation
ि चाशुद्धरक्तिनतप्रिृत्तरक्तं क्षीणरक्तं िा सन्दध्यात् |(Su.Su.16/19)
 When blood found to be vitiated
 Excessive bleeding
 Very less bleeding

29. Continued…..
• रूढोऽनप पररपुटििाि्
िातदुिे रक्ते
• दाहपाकरागिेदिािाि्
नपत्तदुिे
• स्तब्धाः कण्ड
ू िाि्
श्लेष्मदुिे
• श्यािशोफिाि्
अनतप्रिृत्तरक्ते
• अल्िांसोि िृन्धद्धिुपैनत
क्षीणोरक्ते

30. Continued…..
 If blood is contaminated there will be infection.
 Atipravrtha raktha as excessive blood flow lead to
haematoma formation following suturing and will
became a potential source of infection.
 Ksheena rakta can be considered in two senses i. e.
decreased total blood volume of the patient and
decreased blood flow to the grafting site. In both cases
the procedure will not be successful.

31. Abstinence
निर्ट्टिं नदिास्वप्नं र्व्ायाििनतभोििि् |
र्व्िायिनिसन्तापं िाक्श्रिं च निििणयेत् || (Su.Su.16/18)
 Rubbing of ear
 Day sleep
 Exercise
 Excessive eating
 Copulation
 Fire and sunlight exposure
 Excessive talking

32. Indication –when do karna vardhan
िातरोिा सुिर्त्ाण च न्धश्लिसन्धन्धाः सिाः न्धस्थराः |
सुरूढोऽिेदिो यश्च तं कणं ििणयेच्छिैाः ||२५|
After bandh if –
 Hairs have developed
 Looks good ie. Healed properly
 Joint is well adhered
 Skin on both side of suture line is even and stable
 Well healed
 Painless

33. बद्धिात्रं तु याः कणं सहसैिानभििणयेत् |
आिकोशी सिाध्माताः नक्षप्रिेि नििुच्यते ||२४||
 If the ear lobe which has just healed is suddenly made
to grow then it becomes swollen and breaks off
quickly.

34. अनितााः कणणबन्धास्तु निज्ञेयााः क
ु शलैररह |
यो यथा सुनिनशिाः स्यात्तं तथा निनियोियेत् |(Su.Su.16/26)
 Method of joining mutilated ear are innumerable and
should be learnt from expert, that which is appropriate
at the moment should be decided and undertaken.

35. • It is a surgical procedures for
reconstructing a defective,
deformed, or absent external ear,
consequent to trauma or
congenital anomalies e.g.
microtia, anotia etc.
Otoplasty
• It is the surgical procedure
prescribed to repair a split or
torn earlobe.
Lobuloplasty

36. •Auricular lobuloplasty is an easy surgical procedure and has a
low risk of complication with very satisfactory results; therefore,
it should be recommended for patients with lobular deformities.
•Most common procedures done in outpatient basis.
•Inspite of the innumerous techniques used,the ultimate aim of
the surgery is to obtain a soft supple lobule with a well-hidden
cosmetic scar without the complication of recurrence.

37.  Deformities acquired in the ear lobe through the use of
piercings, extenders, trauma, surgery, or aging are
much more frequent than congenital ones, observed in
1:1500 births.

38. Congenital defect

39. Acquired defects
Partial Ear lobe cleft
Total cleft, when the
lobe separates into
two or three ends.

40. Cleft corrections
With preserving the earring orifice.
Without preserving the earring orifice when a
new orifice can be made after three-six
months of healing.
Divided into two large groups

41. Several techniques for reducing and correcting the earlobe
 McLaren- first described repair of partial earlobe clefts using a
simple linear closure by de-epithelializing the partial cleft scar
with a scalpel and closing the margins in a straight-lineslight
scarring of the gap edges and simple suturing of the margins.
 Miller-simple wedge excision to reduce the earlobe
 Boo-chai- proposed the excision of part of the cleft edges and
suture below the original orifice
 Kalimuthu et al. - “V” flap technique, in which a “V” incision
was made at the end of the lobe, followed by de-epidermization
at the medial edge, and another “V” incision at the end of the
lateral edge to fit after the suture.
 Fatah and Fearon & Cuadros - presented the “L” flap technique

42. Procedure for simple repair
 Cleaning and painting the ear lobe
 Infiltration of local anesthesis into lobule
 Excise the scar all around with surgical blade
 Sutured in the anterior and posterior aspect
separately.
 Apply pressure bandage and dressing

43. Anterior ear lobule sutures
Pre Opp Left Ear Lobule

44. Left anterior ear lobule suture removal
Left posterior ear lobule sutures

45. Left ear lobule after 6 months of lobuloplasty

46. Deppressed suture line
•Scar tissue that resides in the
neighboring area of the enlarged
hole that was not completely
excised during lobuloplasty.
•Add step of scoring each
lobular segment into two layers
after excising the scar tissue with
a no 11 surgical blade so as to
incise the scar that adheres the
anterior and posterior layers of
the lobule.

47. Scoring of the scar,
to form anterior (A) layer
and posterior (B) layer
Scoring with undermining of scar
tissue with NO 11 blade

48.  For recurrent enlarged holes and
in very old patient additional
cartilage piece is added
horizontally in the inferior aspect
of the previous hole.
 The convex surface of the cartilage
(harvested from the auricle) is
placed anteriorly.
 This prevent the dragging pull
over the scar in the future.

49. Infiltration of LA
 To prevent multiple pricks
in the lobule to achieve
anesthesia,
 Single prick in the skin fold
that attaches the lobule to
the face can be given.
 At this site the nerve
supplying the whole of the
lobule can be anaesthetized
instantly with a single
prick.

50. Utility of Laser in Lobuloplasty
 Skin incision by surgical blade causes bleeding which
obscures the field and reduces precision. Control of
bleeding is cumbersome for the surgeon because of
the small size of lobule, lack of support and firmness.
 Diode laser of the frequency of 2.5 W and a wavelength
of 850 nm used for skin incision instead of surgical
blade.

51. Advantages
 Diode laser for skin incision-Sharp cutting edge
allowing precise cut
 Better coagulation
 Instant sterilisation reduces bacterial load
 Less operative and anaesthesia time
 Minimum discomfort to surgeon and assistant
 Better healing
 Less scarring

52. Using a tissue adhesive
•A: Excision of cleft edges;
•B: Displacement of the skin edge;
•C: Intradermal suturing and start of
adhesive bonding ( cyanoacrylates)
• D: Adhesive-bonded earlobe and
exposed dressing.

53. Schematic illustration of the adapted "L"
technique
1. Lobe with partial cleft and
vertical elongation.
2. Triangular incision around the
defect.
3. Removal of a small rectangular
fragment from the proximal half of
the defect.
4 and 5. Distal half pulled up and
forward.
6. After suturing and correction of
the defect resulting in shortening
of the lobe

54. Preoperative: partial cleft and lobes
with vertical elongation

55. Immediate postoperative: simple
suture with 5-0 mononylon

56. 2 months after the procedure

57. A surgical incision line was drawn with a marking pen
Flap is designed to transfer
skin from an area of
relative excess to fill a
neighbouring defect.

58. “V” shaped tissue is then advanced
to cover the defect.
Infected part is excised

59. Donor site is sutured in a straight line
which creates a “Y” shaped closure.
Postoperative result at 6 month follow-up

60.  Hypertrophic scar
 Depressed scar
 Wide scars
 Recurrence of the cleft
 Surgical wound infections

61. NEXT PRESENTATION BY : DHRUV
TOPIC: SADYO VRAN