ECS Dr. Merck, Ear Correction System, Constance, Germany
This forum aims at comparing Dr. Merck's stitch method with traditional methods as well as documenting experiences with both kinds of operations.
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Gentle way of otoplasty: Dr. Merck's new stitch method

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PostPosted: 13.12.2005 17:58    Post subject: Gentle way of otoplasty: Dr. Merck's new stitch method Reply with quote

This posting was last updated 27 March 2016 by Priv.Doz.Dr.med.W.Merck, who developed the stitch method 1995 and first used it in 1996:

My stitch method is the first closed, truly minimally invasive method in the world for the correction of protruding ears, with which in the same session all anatomical causes of a protruding ear and also some other malformations of the ears, the cup ear Typ I and Typ II A (Weerda), a protruding antihelix and a second Crus superius of the antihelix (Stahls ear) can be corrected. It is based on the publication of Kaye (1967).
The only wounds are tiny stitch-points on both sides of the ear that heal after a few days and are no longer visible after that. For this method, I have now gathered 17 years of experience with over 10,000 successfully operated ears. There is no clinic in the world, that has ever attained such a number of ear correction operations.
There have never been any serious complications, as can occur with the traditional methods (comparison chart-please click here). The ears are as resilient as before, all the usual movements can be made with the ear. Not once has there been a case of a snapped stitch, because an unbreakable Goretex thread is used. Stitch removals are not needed. With this method, every protruding ear (and often protruding earlobes as well) can be treated, no matter how large the ear, how thick and strong the cartilage or how large and deep the cavum conchae is. There is almost no age limit. My youngest patient was 5 years old, my oldest was 86. If you want to keep the operation secret (common with women) you can hide your ears under a longer hairstyle. You are permitted to go home straight after the operation. You can go back to work or school the very next day. There is no bandage to give away that there has been an operation.
The patient can watch the operation in a mirror and co-determine the position of the ears, which is not possible with the old methods. He can see the result already at the end of the operation. Glasses may be worn immediately.
With the Merck method neither a bandage nor follow-up treatment nor monitoring by a doctor is necessary.
After a few days there are no visible signs of an operation anymore. The result is always a very beautiful, natural looking ear. Nobody will be able to tell that it has been operated on.
There are no more of the numerous risks associated with the traditional operations and some new methods, still cutting or scoring the cartilage. The few remaining risks of the Stitch Method include the rare occurence of thread intolerabilty, resulting in thread rejection and necessitating the removal of the thread to prevent infection. Sometimes the ears can protrude a few millimeters, or sometimes more again after the operation. They can be just as easily, quickly and minimally invasively corrected as in the first operation.

We have been performing the Dr. Merck's Stitch Method in our practice in Constance (Germany) for 17 years, and in the meantime, also in Majorca, Madrid and Tenerife. These centres are the only ones in the world that are exclusively specialised in the otoplasty of protruding ears. This provides a high level of experience and competence.

In contrast to all traditional methods, the Dr. Merck's Stitch Method does not involve the cutting or removal of any skin, connective tissue or cartilage at all. The cartilage of the ear is not exposed, cut, scored, thinned out or worked in any way as is the case with many other methods. Under local anesthetic, and with a special technique of moving a very thin needle in and out, non-absorbable, unbreakable Prolene threads are placed invisibly under the skin of the ear and are then knotted together. Thus, a naturally occurring poorly developed inner ear fold - the technical term is ant helix - is bent more strongly, setting the ear automatically back to the desired position.
If the anatomy of the ear requires it, the same technique can be applied to the correcting of a large and deep conchal bowl ( Cavum conchae ) - this is the bowl-shaped cavity just outside the opening of the ear canal - by moving the antihelix fold in the direction of the ear canal entrance ( I have named it the medialisation of the antihelix ), thus reducing the conchal protrusion and the distance of the ear to the head. No additional operative reduction by cutting or removal of parts of the cartilage or connective tissue is required, as is the case with the traditional methods. Thus, also a Cavum rotation (rotating a big conchal bowl in the direction of the skull and the fixing of it onto the periosteum of the cranial bone) carried out by the open conventional method (Furnas 1968), or the closed method (Fritsch 2004, 2009) is also no longer necesssary.
A very protruding antihelix, which can sometimes be seen in the middle and lower thirds of the antihelix, can be sunk by a special positioning of the threads. In this way it's also possible to avoid an over-folded Antihelix and the hiding of the helix rim behind the Antihelix when looking from the front.
A strong curling forwards and inwards of the outer ear edge (Helix), which sometimes occurs in the upper third of ears, the so-called cup ear Typ I and Typ II A (Weerda), can be uncurled by re-positioning the upper lateral part of the antihelix fold (the so-called crus superius). I have named this the" lateralisation of the crus superius of the antihelix".
A second Crus superius of the antihelix [/b](Stahl`s ear deformity ) can also be corrected.

For further details about the method, its advantages in comparison to the traditional methods and the reactions of the media in Germany, Switzerland and Majorca, please refer to the (comparison chart) or visit http://www.ear-clinic.com/

Confusion between the "Dr Merck's Stitch Method" and other methods that have also been named the Stitch Method incorrectly

In 1995, in order to distinguish my method from all the other methods, I named my method "Stitch Method", a term that hadn't existed in the medical literature until I used it for my method. The name perfectly applies to my method.
Unfortunately some doctors, who don't really know my method, have since then weakened the term by associating some other methods with it:

The Stitch Method is often confused with the old "Mustardé method" or its variants (for example, in Germany by Prof. Heppt and Dr. Bucher). The Mustardé method, however, is an open and bloody method, in which a big cut is made in the skin on the rear of the ear and the cartilage exposed over a large area. It has not proved its worth and is not applicable for every ear especially if the cartilage is thick and strong. The Dr. Merck Stitch Method has nothing to do with the Mustarde Method, because it is a closed, almost bloodless method, in which no cutting of the skin nor exposure of cartilage is made. It is, in contrast to Mustardé and other methods, applicable to every ear, regardless of its shape and size, and how thick and resistant its cartilage is. The reason being, that with the aid of a new, closed and very special technique of moving the needle in and out, it is possible to completely surround the front and rear side of the antihelix cartilage with the threads, which are also anchored there, without having to cut open the ear at all. Thus, a more effective bending of the cartilage is possible than with the Mustarde sewing method, and wounds or their scars later, are no longer necessary for holding the ears.

Dr. Yang from New York suggests, that the "Dr. Merck Stitch Method "only addresses the top of the ear and not the bowl of the ear and therefore some ears require the traditional method. But this is incorrect. My method is suitable both for ears with a poorly developed antihelical fold and for ears with a large and deep cavum conchae (bowl of the ear), or for ears presenting a combination of both malformations. With my method no ears require the traditional method.
Dr. Yang also believes, that my technique is similar if not the same as Fritsch's incisionless otoplasty. My "Stitch Method" is not the "incisionless otoplasty" by Fritsch. The otoplasty of Fritsch is not as minimally invasive as my method; it is, compared to the invasive traditional methods, a reduced invasive otoplasty:
1. With Fritsch's method (2004, 2009), the skin on the frontal surface of the antihelix is elevated and the cartilage is scored. Making incisions in the cartilage is known to be the procedure with many other otoplasty methods. With my method, such incisions are not made and cartilage is not scored anywhere - resulting in the advantage of attractive, round, natural-looking antihelical folds.
In 1995, Fritsch also initially had the idea of using a closed method and not scoring the cartilage anymore. He unfortunately abandoned the idea after that and described in his later publications, that he scored the front side of the antihelix, sometimes penetrating the full thickness of the cartilage Thus, his method unfortunately regressed in the direction of the more invasive and riskier anterior scoring technique of Stenström, that according to Weerda (2004), involves the risks of building sharp, irregular edges of the antihelix and of possible over-corrections. With the Dr Merck Stitch Method, sharp edges and over-corrections are not possible at all; they belong to the past.
2. During the correction of a prominent conchal bowl, Fritsch makes excisions of connective tissue by using cautery near the facial nerve and near bigger vessels. This leads to the possibility of injury of these vessels and the facial nerve.
3. The cutting through of the cartilage of the cauda helicis for the correction of a prominent earlobe and the rotation of a prominent conchal bowl carried out by Fritsch is not necessary with the "Stitch method".
4. Because his method is not as minimally invasive as the "Stitch method", a follow-up treatment is necessary. Dr. Fritsch says: "The patient is asked to place ointment over the puncture points for several days. Water precautions are observed for one week. The patient is seen 3 weeks post-operatively and as needed later. Sometimes an overnight dressing is placed."
With the "Stitch method" of Merck, neither a dressing nor follow-up treatment nor monitoring by a doctor is necessary, not even when a deep conchal bowl is operated on.

With his method, Fritsch didn't describe the possibility of sinking a prominent antihelix, or of removing a cup-like curling of the upper ear outer edge, or removing an artificial third antihelix fold by Stahl's Ear.

The "Incisionless otoplasty" by Fritsch (2004, 2009) is a closed, reduced invasive Stenström technique or a closed, reduced invasive Furnas technique, or a combination of both techniques; the Merck method is a closed Mustardé technique.

Fritsch does not cite in his above-mentioned publications, how many protruding ears he has operated on to date, what complications he has had and how often they have occurred, whereas Merck, in comparison, has reported on all these factors (see the comparison chart above on this page.)

For further details about the differences between the Dr. Merck's "Stitch" method and the "Incisionless otoplasty" by Dr. Fritsch , look in this ears- forum on the page: "Dr. Merck's stitch method - information about Dr. Merck's stitch method for doctors."

Under the name of "Minimal-invasive Otoplastik", Dr. Benedict and Dr. Pirwitz in Germany also offer a method in which the skin is tunnelled through a cut, the cartilage membrane (Perichondrium) raised and the cartilage cut. This method has nothing to do with the minimally invasive technique of the Stitch Method used by "me".

Other doctors (such as Dr. Frank, Dr. Lenze and Dr. Vogt, at the Klinik am Opernplatz in Hannover - Germany) use the method, but inadequately and incorrectly- with the result that they have an unusually great number of complications and therefore choose to combine it with traditional methods.

The doctors Hörl, Rösgen and Dagtekin in Germany offer an operation with a "stitch method" or a variation of it on the Internet. But their methods involve large incisions on the front and on the back side of the ear. With my method, this is no longer necessary.
Dr. Höri turned everything upside down, by asserting that not only my Stitch Method, but also all traditional methods were stitch methods, because stitches were used in all methods.

The doctors Dr. Giebel and Nemecek from the Emotions Clinic in the Czech Republic also advertise with the term "stitch method" for correcting ears, but carry out their operations using the traditional methods.

To state my case absolutely clearly: There is only one "Stitch Method" for correcting ears and that is the method that I use.
There is no other method in the world, that is so minimally invasive, low in risk and regularly produces such beautiful and natural-looking results as the Merck Stitch Method.

Before using my stitch method, I corrected ears with the traditional method for 18 years and thus know the possibilities offered by the traditional method compared with the stitch method. I would never use the traditional method again.

If you are interested in a new, truly minimally invasive stitch method, make sure that you ask any doctor claiming to use it whether he really practises the "Dr. Merck Stitch Method" and whether he can present a certificate proving that he has received professional training for the stitch method from Dr. Merck himself. A tip for showing that the "Dr.Merck Stitch Method" was not used, is a bandage or a treatment required after the operation.
With the Stitch method neither a bandage nor follow-up treatment nor monitoring by a doctor is necessary.[url][/url]
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