A Review of Microvascular Ear Replantation

Abstract

Microvascular ear replantation is a significant challenge because of the small size of the vessels and the fact that traumatic amputations are frequently avulsed. The zone of trauma is therefore extended and the primary repair of the injured vessel is rendered unlikely. The purpose of this study is to review the literature of ear replantation. A review of the relevant literature that has been published since 1980 revealed 47 cases reported in 37 publications. We present 5 cases from our own experience and analyze a total 52 cases of microvascular ear replantation. The patient's age, sex, degree of amputation, cause of injury, ischemic time, method of arterial and venous anastomosis, complications, any additional outflow used, postoperative medications, the requirement for transfusions, and the number of hospital admission days are described. Successful microvascular ear replantations require anastomosis of the vessels if possible. Rather than a vein graft, primary repair of the vessels, or at least pedicled repair of the artery, should be considered to ensure flap survival. In addition, vein repair should be considered if possible to ensure the secure drainage of blood from the replant. With secure circulation, the replant can survive, resulting in a very satisfactory outcome.

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

“…Neither the rate of venous congestion, nor partial or total necrosis, overall complication rate, or length of hospital stay was affected by the mode of vascular reconstruction. These findings confirm recommendations made by Concannon and Puckett, namely that surgeons “should not abandon attempts at replantation because of the inability to establish venous outflow microsurgically” and support the notion that survival of the replant does not appear to depend on performing a venous repair …”

“…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 ).…”

“…Numerous technical modifications, primarily related to different modes of revascularization have been reported since then . Yet, a common postoperative observation has been venous congestion necessitating alternate modes of decongestion, frequently in conjunction with blood transfusions …”

Using an unconventional perfusion pattern in ear replantation-arterialization of the venous system

“…A variety of different approaches have been reported, ranging from stab incisions and application of heparin scrubs to using medicinal leeches . Interestingly, it appears that survival of the replant does not seem to depend on performing a venous repair . One may, therefore, extrapolate that as long as adequate inflow is present, drainage of blood needs to be provided only until neovascularization occurs to establish adequate intrinsic drainage.…”

“…The main technical challenge in ear replantation is related to the venous limb with postoperative venous congestion representing the most common observation . In fact, some authors have substituted venous anastomosis with the use of medicinal leeches …”