Tuesday, June 26, 2007

Mending a Hole

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active.

Mending holes in clothing or in earlobes can be done. Some  methods work better than others. Often with both, simple preventive measures are very useful. When mending clothes, resewing a button before it is lost is best. Using an iron-on interfacing to re-inforce an area in a garment where the fabric is getting thin can prevent the hole from occuring or at least delay it, giving longer life to the garment.

For earlobes, not wearing heavy ear rings can help prevent the stretching of the hole. Being careful when put on or removing clothing so as not to "catch" the earring can help prevent the lobe from being torn. Being careful around babies/toddlers who want to play with shiny/dangling objects can help prevent the lobe from being torn. Another way is to use the "earlobe support" which is a stick-on disc that help support the earlobe when heavy earrings are worn. Used early, this can prevent the stretching or slow tearing of the lobe due to the weight of the earring.

Once the stretching occurs or the tear is completed, then the only way to fix it is to repair it. There are variations on "how" this is done, but they all require excising (freshing) the edges so they can be sewn back together. The variations are mainly in how the excision is structured–straight, z-plastied, or L-shaped. I do not think the straight excision is the best way to do the repair. If the scar "shortens" at all (as straight scars are prone to do), then the lobe is "gathered" up and ends up "W" shaped at the bottom. The other reason is that unless you (the patient) are very good at repositioning the new hole to the side (either) of the scar (which is weaker by at least 20% of the surrounding skin), the tear is very likely to re-occur as the earrings pull-through the scar over time.

The Z-plasy or L-shaped scar avoid the "W" by changing the scar into a non-straight scar. Which one is best will depend on the tear and shape of the earlobe being repaired. Also, it may depend on whether there is an intention to re-pierce the earlobe. Not all do. As I have not figured out how to put sketches in my text, I have linked here to Dr. Michael Bermant, MD site. This is usually an office procedure done using a local block. Most insurances will not cover this procedure as they consider it cosmetic in nature.

A really good article with nice, clear instructions on the Z-plasty technique is REPAIR OF THE SPLIT EARLOBE USING A HALF Z-PLASTY; Journal of Plastic & Reconstructive Surgery, Vol 101(3):855,856, March 1998; Gajiwala, Kalpesh M.S., M.Ch.


EarringDoctor said...

The idea to use an "earlobe support" is a great way to wear any and all earrings again when you have a damaged or torn earlobe.
The hole is temporarily "mended" with the use of Pierce-Mate earlobe supports.
These can be found at http://www.earringdoctor.com/piercemate.html

Belliger said...

Hello, I was a medical officer for the Gurkhas in Hong Kong,(1980's), and their accompanying Gurkha wives had a common problem, of their heavy gold jewellery "cutting out" of their earlobes. I used to re-join the bifid lobes under LA infiltration to the lobe. I removed the "internal" strip of skin in one U-shaped piece, and then apposed the internal soft tissues with a single loop of catgut. After that I mended the skin on the inside and outside, with fine silk sutures. The results were good, though I say so myself. In my opinion, the later strength of the repair lies in the internal catgut suture, not in the fine skin suturing, whether Z-plastied or not. In my opinion it's also essential to place this absorbable internal suture, to prevent a potential internal cavity leading to an [infected] haematoma. I had some training as a plastic surgeon in Newcastle, UK, in 1973. "Belliger," see http://answers.yahoo.com/my/profile;_ylt=Aj6HhCFZZNA4k_Xu2wtLz1bixQt.;_ylv=3?show=4Hw1UWw8aa