Ear Replantation

Abstract

Ear amputations are infrequent but extremely challenging injuries. Ear replantation is the only technique that may result in a near-normal result, although it is technically difficult.

The case of a complete ear amputation in an adult patient treated with microvascular replantation is described. Identification of suitable vessels in the stump and especially in the part requires high-power magnification loupes or microscope. Veins can be difficult to find in the amputated part. Temporary clamp release after arterial repair greatly facilitates vein identification. The skin edges are carefully trimmed to healthy tissue to allow early spontaneous cross-circulation should venous congestion develop. The conchal cartilage is trimmed to allow anterior approach to posterior vessel anastomoses. Vessel size is in the 0.5 mm range and requires supermicrosurgical skills. Vein grafts are taken from the foot and used liberally. After stabilization with skin sutures, the artery is repaired first, the clamp is temporarily released for 5 min and reapplied, and all other microvascular anastomoses are performed before definitive arterial clamp release.

Venous congestion is frequently cited in the literature, and plans for leeching or mechanical drainage should be made, although in the author’s series of four cases it has not been necessary.

Ears are very important bodily parts, and every attempt should be made (by senior and fully trained microsurgeons) to replant an amputated ear.