Successful Bilateral Composite Ear Reattachment

Abstract

Summary:A successful bilateral ear composite graft nonmicrosurgical reattachment is presented. In cases where suitable vessels are unavailable for microsurgical revascularization, the reconstructive challenge can be formidable for salvaging the unique anatomic and aesthetic structure of the ear. The case is presented of an 18-year-old woman who was a victim of an assault wherein both of her ears were intentionally amputated by her attacker. She underwent successful surgical reattachment followed by a postoperative regimen of hyperbaric oxygen, cooling, and meticulous wound care. The patient achieved 100% survival of her left ear graft and 95% survival of her right ear graft. Clinical photographs at 18 months are presented, along with a discussion of the possible implications for other reconstructive applications.

Auricular avulsion injuries: Literature review and management algorithm

“…It has been shown that HBOT enhances oxygen delivery, increases neovascularization, stimulates granulation tissue formation, and reduces tissue edema. [ 34 35 ] In both an animal experimental model study and human cases, data suggest a benefit of HBO therapy to the survival of the re-attached auricular composite graft, even with large segment avulsion. [ 25 34 35 ] Furthermore, this treatment has demonstrated successful effects in minimizing the necrosis of pedicled flaps.…”

“…[ 34 35 ] In both an animal experimental model study and human cases, data suggest a benefit of HBO therapy to the survival of the re-attached auricular composite graft, even with large segment avulsion. [ 25 34 35 ] Furthermore, this treatment has demonstrated successful effects in minimizing the necrosis of pedicled flaps. [ 36 37 ]…”

“…Preferably, venous anastomosis is achieved, but this will not be possible in most cases because of a lack of appropriately sized veins. [ 4 34 38 ] The first successful clinical microvascular replantation of a completely amputated ear was reported in 1980 by Pennington et al . using the vein grafts from the superficial temporal vessels.…”

Salvage of Unilateral Complete Ear Amputation with Continuous Local Hyperbaric Oxygen, Platelet-Rich Plasma and Polydeoxyribonucleotide without Micro-Revascularization

“…Few reports have described the salvage of total ear amputation with nonmicrosurgical revascularization [ 1 ]. Here, we present a case in which it was possible to salvage and replant a completely amputated ear without micro-reanastomosis by implementing a postoperative salvage course including continuous local HBOT, PRP injections, and PDRN injections.…”

“…Systemic HBOT has already been established as an adjunctive treatment to composite grafts for improving and supporting ischemic wounds [ 1 , 2 ], and Thom [ 3 ] described the mechanism of HBOT, reporting that HBOT increased cellular oxygen levels, which, in turn, increased the generation of reactive oxygen species and reactive nitrogen species, which served as signaling molecules in both angiogenesis and protection of ischemia-reperfusion injury pathways. Furthermore, based on these findings regarding HBOT, studies on local HBOT also have been conducted in animal models, and reports showing its efficacy have been published [ 4 , 5 ].…”