Ear Replantation without Microsurgery

Abstract

Reconstitution of the amputated ear remains a challenge to the plastic surgeon. Reattachment as a composite graft of the total or subtotal amputated ear is unreliable. Microsurgical replantation can be performed in a minority of cases; however, difficulty with adequate venous drainage complicates the technical complexity of these cases. To enhance survival of a reattached ear segment, Mladick et al. advocated use of the retroauricular pocket principle. This technique involves deepithelialization of the amputated part, followed by anatomic reattachment to the amputation stump and then burial in a retroauricular pocket. This simple technique increases the surface area of the avulsed segment in contact with surrounding nutrients, maximizing the probability of "take." The relationship between the dermis and cartilage is preserved, thus minimizing the deformity from cartilage warping. The undisturbed dermis on the involved segment can reepithelialize spontaneously, negating the need for a skin graft. We have used this technique successfully in five of six patients.

Successful microsurgical primary replantation of an amputated cheek

“…After 4 days, venous revascularization had established a sufficient venous backflow. Hence, our experience was similar to that of other authors, who could only achieve arterial vascularization of noses [1 Á/4,6] and ears [5,7].…”

Equestrian-Related Injuries: Implications for Treatment in Plastic Surgery

“…Cases involving horse bites were encountered throughout patient records from the past four decades, ranging from a finger amputation requiring replantation, to a shoulder bite requiring repair with a latissimus flap, to an ear amputation requiring replantation. 12,14 Although the anatomy varied, this demonstrated the severe injury that could be sustained because of the forces of a horse bite.…”

A New Method in the Treatment of Ear Amputation

“…6 -8 The auricular prosthesis has been popularized recently. 7 The results of the successful replantations, which were limited in number, were impressive, contrary to the methods listed above. In literature, there was no technique for the treatment of ear amputations that are 1 staged, with short durations and low costs, and applicable to any patient with acceptable esthetic results.…”