The use of the vapocoolant spray does not compromise the sterility of the skin following alcohol prep. Both 70 % isopropyl alcohol antiseptic preparation and skin preparation followed by vapocoolant spray significantly reduce skin colonization when compared to unprepared skin (p < 0.001).

Summary: Venous congestion is a frequent and challenging complication after re-attachment or replantation of avulsed tissues, body parts, and flaps. It is often the reason for failure. One of the successful therapies to prevent and/or treat venous congestion is the use of medicinal leeches. There is sound evidence for its efficacy in plastic and reconstructive surgery for avulsed body parts or flaps. However, there is not enough evidence for its use in ear reconstruction or replantation, especially regarding the fragile tissue of the earlobes. The current study is the first in the literature to describe the use of hirudotherapy for venous congestion in an almost completely avulsed earlobe without microsurgical blood vessel repair, as a last resort in an otherwise healthy 38-year-old male patient who sustained trauma due to physical assault.