Auricular avulsion injuries and reattachment techniques: A systematic review

Abstract

Objective(s)Multiple surgical techniques exist in the acute management of auricular avulsion injuries, including reattachment of the tissue as a composite graft, reconstruction using local skin flaps, the pocket principle, the Baudet method, and microvascular repair. This review aimed to compare the success rates of reattachment methods in auricular avulsion injuries.MethodsA PubMed search systematically identified cases in which (a) an auricular avulsion injury occurred and (b) reattachment was attempted. Search results were combined with an extensive review of references from published studies. In total, 148 cases were identified. Three reviewers independently graded the final aesthetic result of each case using a 5‐point scale. The average grade of each repair was compared to the reattachment method to identify successful techniques.ResultsMicrovascular repair was associated with a statistically significant higher success rate compared to all other reattachment methods. Composite graft reattachment also tended to generate better final aesthetic outcomes, but this difference was not statistically significant.ConclusionMicrovascular repair of the avulsed segment consistently demonstrated higher success rates. Composite graft reattachment should also be considered under the right circumstances. Overall, microvascular repair and composite graft reattachment should be considered the best options in cases of auricular avulsion repair. The authors share a major concern that other methods that rely on the use of periauricular skin will compromise any future attempts for secondary reconstruction, such as staged procedures using costal cartilage grafts. Manipulation of these tissues and in particular burying of the avulsed ear cartilage is discouraged.Level of Evidence4

Arterial only anastomosis associated with modified Baudet technique in ear replantation

“…Most of these patients were aged 20–40 years (48%), followed by those aged 40–60 years (23%), the same age range as in our study patients. [ 6 ] It is assumed that the rarity of this type of trauma is due to the fact that it is often included in polytrauma, in which there may be injuries of much higher severity. [ 14 ] In the current report, as in the other similar studies in the literature, this type of trauma is much more common among men.…”

“…Total auricular amputation can result from animal bites, traffic or workplace accidents. [ 6 ] Over time, the complexity of reconstruction has resulted in the description of many reconstructive techniques useful in cases of total or partial ear amputations. Nonvascularized reattachment of avulsed ears as a composite graft was reported as early as 1898.…”

Reconstructive Options for Auricular Trauma

“…With total avulsion, microvascular re-anastomosis may be attempted within the first 6 hours if vessels are able to be identified. Alternatives to microsurgery include the Mladick technique (de-epithelializing avulsed cartilage and placing it into a postauricular pocket for delayed reconstruction), 11 composite grafting, 12 prosthetics, 13 and autologous rib grafting. The latter is also an option for partial avulsions as described below.…”

Retrospective Study of Management of Near Total Avulsion of Auricles and Review of the Literature

“…Although traumatic ear amputations and avulsions are commonly seen in emergency departments, [1] near-total avulsion is a relatively uncommon but severe injury [2]. It can result in functional and aesthetic disabilities, causing a patient's significant psychological distress [3].…”

“…The microvascular repair has higher success compared to the other methods [2]. Butit is more complicated and postoperative venous congestion may occur.…”