Use of Hyperbaric Oxygen as Adjunct in Salvage of Near-complete Ear Amputation

Abstract

Summary:There have been several cases of microvascular repair of traumatically avulsed or amputated ears in the literature. It seems that, if possible at the time of operation, microsurgical techniques yield the best results. However, because of the nature, complexity, and acuity of traumatic injuries, this option is not always feasible. Although the possibility of microsurgical repair exists, the small size of these vessels is often prohibitive, even for a skilled microsurgeon. Here, we present the case of a 4-year-old boy with almost complete amputation of the left ear attached by an inferior narrow skin pedicle after a dog bite. He was treated with primary repair and postoperative hyperbaric oxygen therapy (HBOT) with good results. This case is another example that even a narrow skin pedicle can contain artery and vein that can supply a large segment of the auricle, making primary repair feasible because of the vascular anatomy and communicating helical arcade. Also, this case demonstrates the successful use of HBOT with a pediatric patient as an adjuvant postoperative therapy.

Primary Reattachment of Near-Complete Ear Amputation: A Successful Outcome

“…The most commonly reported complications after primary reattachment of NEAs in the literature were venous congestion, followed by necrosis of the lobule and necrosis of helical root. 2,5,19 As shown in Table 1, in this study, 1 patient developed a small necrotic area of the ear lobe. This was debrided and eventually healed by secondary intention.…”

“…However, challenges of finding properly sized vessels and postoperative venous congestion may be encountered. 2,8 Furthermore, the technical complexity of microvascular replantation may require specialized expertise and lengthy operative time. With severe crush injuries, microsurgical reconstruction may not be the procedure of choice as the ear’s skin, and cartilage can be severely destroyed.…”

“…Similarly, most of the previously reported cases of NEA were repaired with general anesthesia. 2,3,17,18 Local anesthesia must be used cautiously in these patients as it can increase edema at the pedicle site and can potentially damage the vessels. 13,9…”

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

“…Management of the near-total auricular avulsion injury is a difficult challenge. There are no universally agreed guidelines for the proper treatment of such injuries [11]. The main objective is to obtain the best possible cosmetic result.…”

“…Several reconstructive surgical procedures have been published, including microvascular replantation, simple non-microvascular reattachment as a composite graft, local skin flaps, methods using pocket techniques, and staged autologous reconstruction with rib cartilage [2,5,6]. The success in such cases largely depends on the initial choice of the appropriate surgical approach since many factors influence the surgical outcome [11].…”