Where the loss of substance is not too great and along the helix of the ear, a flap can be taken from the back of the ear, leaving it attached at its cicatrized union with the primary wound, and sliding this flap upward or outward until the defect of the helix is overcorrected to allow for contraction and suturing the flap in its new position. The secondary wound if too large to permit of direct union with sutures may at once be covered with a flap taken from the anterior border of the arm, or, if preferred, from the inner aspect of the calf of the leg. The wound occasioned by the removal of the graft can easily be closed by suture, leaving simply a linear scar of little consequence. Usually such defects of the rim can be hidden by the combing of the hair, especially in women. AURICULAR PROTHESES When the injury has resulted in complete loss of the organ or so much of it that its remaining stump will not permit of otoplasty, protheses or artificial ears or parts of ears may be employed to render the patient less unsightly. These protheses are usually made of aluminum, papier maché, or rubber, and painted to match the good ear. They are attached with a special kind of gum, termed zinc-leim, which makers of such protheses furnish, or are held by metal springs, which are inserted under strips or bridges of skin surgically created for the purpose. The esthetic effect is surprisingly good in most cases. COLOBOMA A very common injury observed in women is laceration of the lobule of the ear or ears, generally due to the wearing of heavy earrings, which gradually cut their way through the tissues. Coloboma may be occasioned by the forcible tearing out of the earrings; it has also been found to be congenital in rare cases. The simplest method for correcting this deformity is to cut away both cicatrized edges of the defect by the aid of the angular scissors, exposing fully the width of the lobular tissue on both sides (Fig. 116), as the cicatricial edges are likely to be thinner than the lobule proper, and if brought together would leave a depression along the line of union. The freshened cut surfaces are brought together with fine silk sutures, an inferior one being taken in the outer border, so as to establish perfect coaptation at this point (Fig. 117). The objection to the above operation is that invariably owing to the resultant contraction a notch is formed at the union of the angles of the freshened wound. To avoid this the operation shown in Fig. 118 is to be employed (Greene). [Illustration: FIG. 116.—CORRECTION OF LOBULAR DEFECT.] [Illustration: FIG. 117.—COAPTATION OF WOUND.] [Illustration: FIG. 118. FIG. 119. GREENE METHOD.]