Split Earlobe Repair Using a
Double-Flap Technique
The authors describe a new method for the reconstruction of the
split earlobe in which the earring hole is retained in its original
position using double skin flaps to strengthen the repair.
Staiano JJ, Niranjan NS. Split earlobe repair using a double-flap tech-
nique. Ann Plast Surg 2001;47:89 91
From the St Andrews Centre for Plastic Surgery and Burns, Broomfield
Hospital, Chelmsford, Essex, UK.
Received Dec 21, 2000. Accepted for publication Feb 3, 2001.
Address correspondence and reprint requests to Mr Niranjan, St Andrews
Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford,
Essex, CM1 7ET, UK.
The common problem of split earlobes has encour-
aged much discussion in the surgical literature.
Ideally, the original position of the earring hole is
preserved so that earrings remain symmetrical, es-
pecially in unilateral tears. However, this poten-
tially leaves a vertical scar that renders the earring
susceptible to being pulled through.
We describe a technique that can be used for
complete or incomplete tears that retains the
earromg hole in its original position and offsets
the scar using double skin flaps to strengthen the
repair.
Surgical Technique
The markings of the lobe are as follows. The
length of the split is divided into thirds and the
Fig 1. The defect is divided into thirds, and the lower
two-thirds are marked as shown. The edge of the second
flap is freshened from the top to the tip.
J. J. Staiano, FRCS
N. S. Niranjan, FRCS
lower two thirds is marked on either side of the
split. The skin is removed to freshen the edge
from the top to the tip on one side, as shown in
Figure 1. A no. 11 blade is used to incise along
the markings, which results in two skin flaps, one
with intact skin and the other with a raw area on
both sides (Fig 2).
The first flap is rolled to the top of the cleft or
split and is sutured (Fig 3). This reforms an
epithelial-lined hole for the earring. The sec-
ond flap is sutured to the raw surface of the
first. The rest of the lobe is sutured together (Fig
4). This maintains the hole in its original posi-
tion, and at the same time two skin flaps
support the earring.
Discussion
Heavy earrings can enlarge the holes of the ear-
lobe, and a complete tear can occur when there is
accidental snagging or pulling. After sustain this
injury, patients find it difficult to continue to
wear earrings because they feel self-conscious or
experience pain. After sustaining a complete tear,
they are unable to wear any ear ornamentation.
Fig 2. The markings are incised to create two flaps.
Fig 3. The first flap is sutured to the tip of the split to
recreate the earring hole.
Fig 4. The second flap is sutured to the raw surface of
the first, and the rest of the lobe is sutured together.
Copyright 2001 by Lippincott Williams & Wilkins, Inc. 89
Annals of Plastic Surgery Volume 47 / Number 1 / July 2001

Fig 5. Repair of an enlarged hole using the double-flap technique. (A) The enlarged hole. (B) The 4-month
postoperative result. (C) The flaps are marked. (D) The flaps are sutured.

90
 Tips & Techniques: Staiano and Niranjan: Reconstruction of Split Earlobe
Fig 6. Repair of a complete split using the double-flap technique. (A) Complete split. (B) Result 2 months
postoperatively.
Techniques for repair can be divided into those
involving direct suture and those using local
flaps with and without preservation of the earring
hole.
We discuss the various options with patients.
Closing the hole completely and repiercing the
ear at a different level creates asymmetry,
whereas maintaining the hole without any skin
flaps may result in a dehiscence on return to
earring wear as a result of weakness of the scar
tissue. On direct questioning we have found that
patients prefer to maintain the hole in its original
location, centered on the earlobe and symmetri-
cal with the other side.
Current techniques to maintain the original
hole for an earring involve either suturing around
a stent or bringing a flap of skin to the apex of the
cleft to recreate an epithelial-lined hole. Boo-
Chai1 described leaving the apical epithelium
intact and suturing around a matchstick, but this
leaves little support for the earring. A single flap
such as that described by Pardue2 would provide
more support, and the addition of Z-plasty as
described by La Rossa and Hamilton3 is a further
improvement. The technique described herein
produces an even stronger cradle of tissue on
which the earring can sit by double-breasting
two flaps (Figs 5 and 6).
This technique maintains the earring hole at
the center of the earlobe and produces satisfac-
tory results. It is simple, and all patients have
been happy with the repair.
References
1 Boo-Chai K. The cleft earlobe. Plast Reconstr Surg 1961;28:
681 688
2 Pardue AM. Repair of torn earlobe with preservation of the
perforation for an earring. Plast Reconstr Surg 1973;51:472
473
3 La Rossa D, Hamilton R. Method for repair of cleft earlobes.
Plast Reconstr Surg 1975;55:99 101
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