Three cases of successful microvascular ear replantation after bite avulsion injury

Abstract

We present three cases of sub-total amputation of the external ear caused by bite avulsion injury. The ears were all successfully replanted despite us being unable to perform a venous anastomosis in one case. These outcomes support attempted microsurgical replantation for total or sub-total amputations of the ear, as successful replantation is the most effective surgical option.

Microsurgical ear replantation—is venous repair necessary?—A systematic review

“…For the purpose of further analysis only cases of arterial and venous reconstruction (group 1 [ N = 38]) and artery‐only anastomosis (group 2 [ N = 19]) were included. The duration of surgery was reported in 23 cases in group 1 and 9 cases in group 2 with the median duration of surgery being 6 and 4 hour in group 1 and group 2, respectively ( P < 0.005; Table ).…”

“…For the purpose of further analysis only cases of arterial and venous reconstruction (group 1 [N 5 38]) and artery-only anastomosis (group 2 [N 5 19]) were included. The duration of surgery was reported in 23 cases in group 1 12,14,15,[47][48][49][50][51][52][53][54][55][56][57][58] and 9 cases in group 2 9,16,17,[59][60][61][62][63][64] with the median duration of surgery being 6 and 4 hour in group 1 and group 2, respectively (P < 0.005; Table 2 Table 2). The lack of statistical significance for these metrics was additionally confirmed using logistic regression to evaluate the effect of group type (1 vs. 2) on each outcome while adjusting for geographic region, type of institution, mechanism of injury, and complete vs. partial injury (P 5 0.35 -1.0).…”

“…While numerous authors have demonstrated successful ear replantation following artery‐only anastomosis while ensuring venous drainage via alternate means, including medicinal leeches and use of heparin‐soaked scrubs, the question remains whether this practice is associated with a higher transfusion requirement and complication rate. The low incidence of ear amputation precludes the ability to answer these questions by means of prospective trials.…”

“…A meaningful analysis of the methods of venous decongestion (including medicinal leech therapy and blood drainage through puncture wounds/small incisions), as well as postoperative anticoagulation regimen was not possible given the heterogeneous protocols employed and comparatively sparse datasets.…”

Microsurgical Replantation and Salvage Procedures in Traumatic Ear Amputation

“…Microvascular replantation offers an excellent esthetic outcome if microanastomoses between the recipient vessel and amputated ear are available to reestablish arterial inflow and venous outflow. [5][6][7][8][9][10][11][12][13] In many situations, however, not all of the recipient sites can provide suitable vessels for anastomosis. When a suitable artery exists, but no vein for microanastomosis, the outcome of the replanted ear is unpredictable, and a technique for relieving the venous congestion is mandatory.…”