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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Misunderstandings of the term "stitch method"

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Dr. Merck

PostPosted: 15.01.2006 20:00    Post subject: Misunderstandings of the term "stitch method" Reply with quote

This posting was last updated 1 November 2013 by Priv.Doz.Dr.med.W.Merck, who developed the stitch method and first used it in 1995:

Dear colleagues,

In 1995, I began performing the stitch method for otoplasty, based on the publication of Kaye (1967). The fundamentals of an effective and permanent positioning of the threads in an ear were worked out on pigs' ears.
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.

In 1999, I started to report of my method and the results I was achieving. At conventions I referred to it as a "Minimally invasive method for otoplasty, the Stitch Method" because the only stabilising and fixing elements are the invisibles stitches under the skin.
The processing of the cartilage in the form of thinning out, cutting, scoring, scratching or excisions of cartilage is completely dispensed with. Wounds, or rather their subsequent scars for the support of the ears, no longer occur and have since turned out to be no longer necessary. The scoring of the cartilage on the front side of the antihelix, as deemed necessary by Cricelair (1963), Kaye (1967), Mouly (1971), Tramier (1995), Peled (1995), Fritsch (2004,2009) und Benedict (2005), is not a part of my stitch method and is not necessary. In this way, the traumatisation of the ears with the Merck Stitch Method is, in contrast to the methods of the above-mentioned authors, further diminished and my method can now be truly spoken of as a minimally invasive and absolutely closed technique. It is closed because the ear is not opened at any place by big or small cuts; it is minimally invasive because the skin and the cartilage membrane (perichondrium) are not tunnelled at any place any longer, nor is the cartilage scored anymore. Depending on the anatomical characteristics, varied positioning of the threads and their knots are used that differ considerably from the positioning described by the above-mentioned authors.

With the first use of the term "Stitch Method" in the surgery of protruding ears, I had hoped there would be a clear differentiation from the other otoplasty terms. In the medical literature, the terms "stitch method" or "stitch technique" are not to be found for any other ear correction method, not even as collective terms for various techniques.

To my surprise and disappointment, I noticed that the term "Stitch Method" was seen by colleagues (who misunderstood me or did not get proper information) as the Mustardé method or a variant of it. They thought I had modified this old method and used it now under the new term "stitch method". The "Merck Stitch Method", however, has got nothing to do with the Mustardé technique. The Mustardé method is an open, bloody method with cutting and undermining of the skin and subcutaneous tissue and using retention sutures. In contrast, mine is the first completely closed and truly minimally invasive method for otoplasty with none of the risks associated with the Mustardé method and other methods. With my method, as opposed to the Mustardé method, any ear can be operated on, no matter how thick and resistant the cartilage is, because the threads can be placed more systematically around the cartilage of the antihelix (and anchored there), than can be done with the Mustardé method. This is due to a different needle insertion technique.
A large and deep conceal bowl can be reduced by the medialisation of the antihelix, a prominent antihelix can be sunk by changing the positioning of the threads, without cutting or removing any cartilage or subcutaneous tissue.
Even protruding earlobes are not corrected anymore with the usual cutting and resection techniques, but can be brought into the right position with the Stitch Method in the same session as 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 cavum conchae (bowl of the ear), or for ears presenting a combination of both malformations. With my method, no ear requires the traditional method.
Dr. Yang also believes, that my technique is similar if not the same as the incisionless Fritsch otoplasty. My "Stitch Method" is not the "Incisionless otoplasty" by Fritsch.
There are many differences between the "Incisionless otoplasty" by Fritsch and the Merck method:

1. Fritsch (2004,2009) elevates the skin along the anterior surface of the antihelix and scores the cartilage. Making incisions in the cartilage is known to be the procedure with many other otoplasty methods (Stenström technique). 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 scores 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 Merck´s Stitch Method, sharp edges and over-corrections are not possible at all; they belong to the past.

2.The cutting through of the cartilage of the cauda helicis by the correction of a prominent ear lobe carried out by Fritsch is not necessary with the "Stitch method".

3. Fritsch performs the correction of a big, deep cavum conchae by rotation with concha mastoid sutures. He makes a skin incision and removes an amount of connective tissue. This is the Furnas method (Furnas 1968). With the Merck method, a large and deep cavum conchae (conchal bowl) can be reduced only by the medialisation of the antihelix, without skin incisions and removal of connective tissue.

4. The "Incisionless otoplasty" by Fritsch is not as minimally invasive as the "Stitch method", as the Fritsch otoplasty even includes the danger of injuring the facial nerve and the branches from the postauricular artery and vein, because during the operation of a protuberant conchal bowl Fritsch removes an amount of connective tissue near the facial nerve by cautery and writes: "During cautery, the surgeon is cognizant of the course of the facial nerve exiting from the anterior mastoid tip. A small skin incision may be necessary to better view the operative field if bleeding is suspected".
With the Merck method, there is never the possibility of injuring the facial nerve or the postauricular artery and vein.

5. Follow-up treatment is necessary with the Fritsch method, because if the surgery is limited to the antihelical fold, Fritsch recommends the application of a topical antibiotic ointment and keeping the ears dry for a week. When Fritsch operates on a big cavum conchae, he considers it advisable to put a bilateral mastoid-type dressing on for 24 hours
With the "Dr. Merck Stitch Method", neither a postoperative dressing nor follow-up treatment nor monitoring by a doctor is necessary, not even when a conchal bowl is operated on.

6. With his method, Fritsch didn't describe the possibility of sinking a prominent antihelix.

7. Fritsch didn`t describe the correction of a cup-like curling of the upper ear outer edge by simple lateralisation of the crus superius of the antihelix. He performs it with many small retention sutures combined with a wedge excision.

8. Fritsch also didn't describe the removing of an artificial third antihelix fold in a Stahl's Ear.

9. 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)

The "Incisionless otoplasty" by Fritsch (2004, 2009) is a combination of a reduced invasive technique with the traditional Stenström technique and the traditional Furnas technique.

The "stitch method" by Merck is the first truly closed, minimally invasive otoplasty.

For anyone requiring further information, please read more in this forum and refer to my homepage at www.merck-ecs.com.

Finally, I kindly ask you to make correct statements to patients about the "Dr. Merck Stitch Method" and not to claim, as is done very often at the moment, that it is the old Mustardé method or a modification thereof, or the "Incisionsless Otoplasty" by Fritsch.
The assertion that my method often doesn't work is incorrect. My method has meanwhile been proved successful on more than 8000 ears and shows that my method really works. This is a number that no colleague or clinic operating with another method has achieved till now.

Best regards to all my colleagues,
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PostPosted: 30.05.2006 13:44    Post subject: Reply with quote

Dear Dr Merck,

We should be grateful, if you could tell us more about your method and how you do it??

Thank you
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PostPosted: 01.06.2006 17:47    Post subject: Reply with quote


If you practice medicine and would like to have further information on my method, than you can find it here or on my website (www.merck-ecs.com). We recommend that you participate in one of our seminars for doctors in Mallorca.
If you would not like to attend a seminar, or are unable, please write me exactly what it is you would like to know.

Kind regards,
Priv. Doz. Dr. W.med. Merck
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Joined: 10 Sep 2006
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PostPosted: 10.09.2006 07:03    Post subject: stitch method Reply with quote

Hi, I'm very interested in this method and therefore would like to ask you to send me step-by-step procedures so I can understand it better, even photos if you have them. I will be attending one of the seminars also.
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Joined: 29 Nov 2005
Posts: 12

PostPosted: 16.09.2006 20:48    Post subject: Reply with quote

Dear dday,

To guarantee that the stitch method has been correctly understood, we hand out this kind of information (including photos) only in our seminars for physicians. If the physicians have understood how the method works and how they have to operate with the method, they recieve a cerificate.
This certificate documents their participation at the seminar and certifies that they have learned the application of the stitch method.

Kind regards,

Priv. Doz. Dr. med. W. Merck
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