Auricular avulsion injuries: Literature review and management algorithm

Abstract

Traumatic ear avulsion (TEA) may have tremendous psychological consequences if not managed properly. There are no clear guidelines on the surgical management of these injuries, especially in developing countries where microsurgical facilities are lacking. We aimed to review the literature on surgical management of TEA with the main focus on direct re-attachment (DR) so as to develop a surgical management algorithm that can be applied in the absence of microsurgical facilities. We performed an extensive review of the relevant English literature on papers indexed in PubMed describing TEA repaired with DR without restriction to a specific publication time window. A total of 28 cases in 18 publications were reviewed and analyzed. Our results indicate that in the acute setting with no available microvascular expertise, DR of auricular avulsion injuries can be better than other nonmicrosurgical techniques in generating good esthetic results, especially in incomplete auricular avulsion and small segment avulsion. The operative approach depends on the clinical setting. DR of the auricular avulsion injuries is an accepted approach. It produces good cosmetic outcomes while preserving the auricular area for future reconstruction in case of re-attachment failure.

Prognostic factors in partial auricular avulsion after one-stage reconstruction

“…In the included studies, all cases experiencing complications were admitted to the hospital five hours or more (5 to 22 h) [ 7 , 4 , 8 , 10 ]. A recent review by Al-Ali et al explained the non-essential role of injury to surgery time due to the low metabolic demand of the ear, however, had increased rate of venous congestion [ 3 ]. Several detailed technical aspects might be considered in conducting the simple reattachment technique.…”

“…Microvascular repair appears to be the best aesthetic outcome, however the need for blood transfusion and higher operative time should considered [ 2 ]. Surgical approach for auricular avulsion broadly classified from the total of operation needed defined as ‘stage’, such as ‘one-stage’ for a single operation or ‘two-stage’ (or more) when prior surgery was needed to create the framework for the avulsed ear [ 3 ]. Here we presented a partial auricular avulsion receiving ‘one-stage’ direct re-attachment.…”