OT notes · ENT

Earlobe repair (lobuloplasty)

Usual anaesthesia
Local infiltration at the base of the pinna (minor OT)
Position
Supine, head turned to the opposite side
Setting
elective

Operative note template for repair of a split or elongated earlobe under local anaesthesia, with a filled example for a complete earlobe split caused by heavy earrings.

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Blank template

Follow this order in the case sheet. Tick the options that apply and fill the blanks.

Patient and case

  1. Name / Age / Sex
  2. UHID / IP no. / Ward-Bed
  3. Date of surgery / OT no.
  4. CaseElectiveEmergency (non-elective)if emergency, state urgency and reason
  5. Timesin OT ___ anaesthesia start ___ incision ___ closure ___ out of OT ___

Team

  1. Operating surgeonname, designation
  2. Assistant(s)
  3. Supervising consultantpresent in OT / available / not applicable
  4. Steps done by the residentwhole procedure / named steps, under whose supervision
  5. Anaesthetist
  6. Scrub nurse / circulating nurse

Diagnosis and procedure

  1. Pre-operative diagnosis
  2. Post-operative diagnosis
  3. Procedure planned
  4. Procedure performedif different from plan, state why
  5. Extra procedure done and reason'none' if none. Only to save life or health if not consented

Consent and safety checks

  1. Informed consentGeneralProcedure-specificHigh-riskAnaesthesiain a language the patient understands: language ___ witness ___
  2. Site / side markedYesNot applicable
  3. WHO Surgical Safety ChecklistSign inTime outSign out
  4. Antibiotic prophylaxisdrug, dose, route, time given before incision
  5. VTE prophylaxisMechanicalPharmacologicalNot indicated

Risks to explain in the consent for this operation

  • bleeding and haematoma
  • infection
  • visible scar or notch at the lower edge of the lobe
  • thick or keloid scar
  • wound opening up
  • earlobe shape or size not the same as the other side
  • the lobe may tear again if heavy earrings are worn

Pre-operative details for this operation

  1. SideRightLeftBilateral
  2. Type of defectComplete split (cleft through the lower edge)Incomplete split / elongated piercing holeAbsent / deficient lobeAttached earlobeLarge (fleshy) lobelength of cleft in mm; cause (earrings, trauma)
  3. Previous repair or keloidNonePrevious repairKeloid history
  4. Photograph before surgeryTakenNot taken
  5. Patient's wish about re-piercingrecorded

Anaesthesia and position

  1. AnaesthesiaLocal infiltration at base of pinnadrug, strength, volume
  2. Cotton plug in ear canalPlaced
  3. PositionSupine, head turned to opposite side

Operative findings

  1. Cleftlength, edges epithelialised, thickness of lobe
  2. Other earlobenormal / also stretched

Procedure (steps)

  1. Parts painted and drapedantiseptic used
  2. Incomplete split / holeTear completed with No. 11 bladeNot completed: edges freshened only
  3. Edges freshenedepithelium excised all around the cleft with No. 11 blade
  4. Lower edge repaircorner at the free border lined up and sutured first; any other technique named
  5. Suturing ordercorner (free border) first, then anterior surface, then posterior surface
  6. SuturePolypropylene (Prolene)Polyamide (Ethilon / nylon)Silksize (fine, e.g. 5-0), interrupted simple sutures

Closure, drains and dressing

  1. Skinnumber of sutures front and back
  2. DressingLight dressingNone
  3. Cotton plug removed from ear canalYes

Specimens and implants

  1. SpecimensNone (edges discarded)Keloid tissue sent for HPE
  2. ImplantsNone

End of procedure

  1. Estimated blood lossml
  2. IV fluids and blood / products givenfluids (ml); blood: type, units, bag nos.
  3. Swab, needle and instrument countCorrectIncorrect: action taken
  4. Intra-operative complications / difficultieswhat happened and what was done; 'none' if none
  5. Implant stickersNo implantAffixed in case sheet, OT register and for discharge summary
  6. Condition at end of surgery / shifted toPACUWardICU/HDU

Post-operative orders

  1. Wound carekeep dry and clean
  2. Analgesiadrug, dose, frequency
  3. Bleeding or swellingfirm pressure; return if it continues
  4. Suture removaldate as advised
  5. Earringsno earring in the operated lobe until the surgeon allows; avoid heavy earrings in future
  6. Warning signsredness, discharge, fever, thick raised scar: come back

Signature

  1. Name and designation of person writing note
  2. Medical Council registration no.
  3. Signature / date / time of writingwrite before the patient leaves recovery

Worked example

Fictional case: Mrs. L.B., 35 years, left earlobe split completely through the lower edge over 5 years from heavy earrings; wants repair before a family wedding.

Case details

Date: 25/11/2026. Elective, day case. General surgery / ENT minor OT.

Start 11:10. End 11:40.

Surgeon: Dr A. (1st-year resident). Supervising: Dr C. (senior resident), present.

Nurse: Sr E. Anaesthesia: local, by surgeon.

Indication and pre-op

Left earlobe: complete cleft 12 mm long through the lower edge, edges healed with skin. Right lobe: piercing hole stretched to 4 mm, not split; patient does not want it done now.

No keloid in the past. No previous repair. Photograph taken with consent.

Consent: procedure-specific consent in Hindi. Scar, notch at the lower edge, keloid, infection and re-tearing with heavy earrings explained. Patient told not to wear an earring in the left lobe until allowed.

Time out done: side (left) confirmed. No antibiotic prophylaxis given.

Anaesthesia and position

Supine, head turned to the right. Cotton plug placed in the left ear canal. Parts painted with povidone-iodine and draped.

Local infiltration at the base of the left pinna with 2% lignocaine (xylocaine), 2 ml.

Procedure and findings

Cleft 12 mm, lobe of normal thickness.

Skin-lined edges of the cleft freshened all around with a No. 11 blade, removing a thin strip of epithelium from both sides.

Corner at the lower free edge sutured first to line up the border, then the anterior surface and then the posterior surface with interrupted polypropylene (Prolene) 5-0.

Four sutures in front, three behind. Lower edge smooth, no notch.

Closure

Light dressing. Cotton plug removed from the ear canal.

End of procedure

Blood loss minimal.

Needle count correct.

Specimen: none; freshened edges discarded in the yellow bag.

No complications. Discharged home at 12:10 in stable condition.

Post-op orders

Keep the ear dry and the dressing clean.

Tab paracetamol as per prescription if pain.

If bleeding, press firmly on the lobe; come back if it does not stop.

Suture removal in the minor OT on the date written on the discharge card.

No earring in the left lobe until allowed by the surgeon; avoid heavy earrings in future.

Come back for redness, discharge, fever or a raised scar.

Signature

Dr A., JR-1. Reg. no. ________. 25/11/2026, 11:50.

Must document for this operation

  • Type and length of the defect, and a photograph before surgery. This is often a cosmetic operation, and the before state is needed if the patient is unhappy with the result.
  • How the lower free edge was repaired. A scar or notch at the free border is the most visible fault, and the note shows the step taken to avoid it.
  • Suture material, number and removal plan. Whoever removes the sutures needs to know how many there are and where, front and back.
  • Keloid history. Keloid after ear surgery is a known risk, and a past history changes the counselling and follow-up.
  • Advice given about earrings and re-piercing. Early or heavy earrings are the usual reason for a repeat tear, and written advice protects the surgeon.

Common mistakes in these notes

  • Writing 'earlobe repaired' with no side, defect length or technique.
  • No pre-operative photograph for a cosmetic procedure.
  • Not recording the number of sutures on each surface.
  • No written advice on earrings.
  • Leaving out the cotton plug in the ear canal, then forgetting to remove it.

Indian practice and paperwork

  • Consent must be in a language the patient understands and must say who will do the procedure. (NABH 5th ed., PRE.4(c))
  • Freshened skin edges not sent for HPE are human anatomical waste for the yellow bag. (Bio-Medical Waste Management Rules 2016, CPCB guidelines)
  • Even for a minor OT procedure, the operative note must be written before the patient leaves recovery. (NABH 5th ed., COP.14(e))

Sources

  • Gvalani AK. Manual of Instruments and Operative Surgery. 2nd ed. CBS Publishers & Distributors, Ch 31, Minor operations: ear lobe repair (auroplasty); wound suturing, pp. 132-134.
  • Theissing J, Rettinger G, Werner JA. ENT-Head and Neck Surgery: Essential Procedures. Thieme; 2011, Ch 15, Surgery of the auricle and ear canal: surgery of the earlobe (reduction, attached earlobe, reconstruction), pp. 337-338.
  • Hathiram BT, Khattar VS, eds. Atlas of Operative Otorhinolaryngology and Head and Neck Surgery. Jaypee Brothers, Ch 4, Preauricular sinus (Khattar VS, et al.): keloid as a complication of ear-region skin surgery, pp. 41.

Educational template for residents. Adapt it to your institution's case-sheet format and your consultant's instructions. Patient details in the example are fictional.

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