The Merck stitch method is a minimally invasive procedure for pinning protruding ears, developed by Merck.Merck, W.H. (2013). "Dr Merck’s stitch method. A closed minimally invasive procedure for correction of protruding ears (Die Fadenmethode nach Dr. Merck. Ein geschlossenes, minimal-invasives Verfahren zur Anlegung abstehender Ohren)." ''J Aesthet Chir'', 6, 209-220. The method belongs to the special types of ear pinning surgeries. In contrast to other variations of minimally invasive proceduresTramier, H. ''Personal approach to treatment of prominent ears.'' In: ''Plastic and Reconstructive Surgery.'' 99, Number 2,, 562–565, .Vecchione, T.R. 1979 ''Needle scoring of the anterior surface of the cartilage in otoplasty.'' In: ''Plastic and Reconstructive Surgery.'' 64, Number 4, 568, . the stitch method does not use additional techniques from the traditional ear pinning surgeries (

otoplasty Otoplasty ( el, οὖς, , "ear" + , , "to shape") denotes the surgical and non-surgical procedures for correcting the deformities and defects of the pinna (external ear), and for reconstructing a defective, or deformed, or absent external ear, co ...

). It belongs to the closed ear pinning surgeries because the ear is not cut open for the placement of the sutures. According to the experience of the author the Stitch Method is suitable for all protruding ears. The stitch method is the most frequently performed otoplasty among the minimally invasive methods.

History

The technique of the stitch method, as well as its results and possible risks, was described by Merck in 2013. According to his information, he developed it in 1995 and used it on a great number of patients from 1996. FritschFritsch, M.H. (1995). "Incisionless Otoplasty". Laryngoscope''. 105, 1-11 also operated on 13 patients with this technique, but did not restrict himself solely to it, and combined it with the conventional Furnas method. In his later publications Fritsch abandoned this method in the belief that permanent results could only be obtained if the anterior surface of the antihelix fold was pierced, scored or deeply incised, and cut through completely at times. He did this with the aim of reducing the tension in the cartilage in this way. According to Merck, this is not necessary and he proved this on several thousand operated ears.

Surgery

Through stab incisions in the retroauricular sulcus (the groove behind the ear), permanent, non-absorbable sutures are placed invisible under the skin around the

cartilage Cartilage is a resilient and smooth type of connective tissue. In tetrapods, it covers and protects the ends of long bones at the joints as articular cartilage, and is a structural component of many body parts including the rib cage, the neck an ...

of the

antihelix The antihelix (anthelix) is a part of the visible ear; the pinna. The antihelix is a curved prominence of cartilage parallel with and in front of the helix on the pinna. The antihelix divides above into two ''legs'' or crura; the ''crura antiheli ...

using a special technique, pulled tight and knotted. When the sutures are tightened, the ear moves towards the head. The cartilage is not worked on. A protruding earlobe can be pinned closer to the head with the Merck stitch method if the cartilage of the ear extends a little into the earlobe.

Complications

Pain; suture

extrusion Extrusion is a process used to create objects of a fixed cross-sectional profile by pushing material through a die of the desired cross-section. Its two main advantages over other manufacturing processes are its ability to create very complex c ...

; infection; rare suture

granuloma A granuloma is an aggregation of macrophages that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such substances include infectious ...

atheroma An atheroma, or atheromatous plaque, is an abnormal and reversible accumulation of material in the inner layer of an arterial wall. The material consists of mostly macrophage cells, or debris, containing lipids, calcium and a variable amount o ...

; slight, harmless post-operative bleeding;

relapse In internal medicine, relapse or recidivism is a recurrence of a past (typically medical) condition. For example, multiple sclerosis and malaria often exhibit peaks of activity and sometimes very long periods of dormancy, followed by relapse or r ...

(recurrence of protruding ear).

References

{{Reflist Ear surgery 11. Merck, W.H. (2017). "Ohrmuschelkorrektur ohne Hautschnitt - die Fadenmethode von Merck. In: K.Bumm (Herausgeber): Korrektur und Rekonstruktion der Ohrmuschel." Springer, 153-169.