Leeching as Salvage Venous Drainage in Ear Reconstruction: Clinical Case and Review of Literature

Abstract

Background:Ear avulsion is a rare complication of different traumas, such as car accidents, human or animal bites and stab wounds, and can result in dramatic cosmetic consequences for the patient. Ear replantation, revascularization, and reattachment are the options offering best aesthetic results. But venous outflow insufficiency is responsible for a high rate of failures. Leeching is one the most efficient methods to relieve venous congestion. It has been used as an alternative venous outflow in case of severe impairment of the physiologic one.Methods:We present a case of successful rescue of a congested reattached ear by leeching after subtotal avulsion, along with a review of the literature on cases of avulsed auricle reconstruction salvaged by hirudotherapy. Data were collected and analyzed to identify a best regimen to deal with venous congestion.Results:More than 130 cases of avulsed auricle savage are described in the literature, in a fourth of which leech therapy was used in the management of venous congestion.Discussion:In case of both venous outflow deficit or absence, leeches are a potentially successful option to correct the congestion while new veins reestablish normal physiology. The need for anticoagulant/antiaggregant therapy, antibiotics, and often blood transfusion are the main pitfalls of leeching.Conclusion:Leeches can be considered a salvage method for ear replantation and reattachment in those cases that lack venous outflow in the presence of valid arterial inflow.

Non-microvascular Successful Management of Near-total Ear Avulsion

“…On the other side, some authors recommended the use of systemic anticoagulants alone or in addition to medicinal leeches to maintain venous outflow. 9 …”

Auricular complications following temporal bone resection for temporal bone malignancies: a clinical consideration

“…A clear consensus on the guidelines for treating external ear congestion is lacking. Tissue milking, pin pricking,(12) use of medical leeches, (13,14) mechanical leeching, (15) and chemical leeching(16) are the current treatment methods for venous congestion. In our two cases, mechanical bloodletting effectively salvaged the auricular necrosis.…”

Leech Therapy for Complex Facial Lacerations

“…Traction injuries can further create microsurgical difficulties given the limited supply and ill-defined collection of small vessels. 14,15 As a result, in cases of complete detachment, some opt to forgo reimplantation in light of other approaches to treatment in fear of futile effort and failure. 15 Momeni et al 16 showed favorable outcomes with auricular reimplantation despite the abandonment of microsurgical venous reanastomosis.…”

“…14,15 As a result, in cases of complete detachment, some opt to forgo reimplantation in light of other approaches to treatment in fear of futile effort and failure. 15 Momeni et al 16 showed favorable outcomes with auricular reimplantation despite the abandonment of microsurgical venous reanastomosis. This approach may be applicable to avulsion repair and successful for multiple grades of injury.…”

“…Simultaneously, this is met with a lower vascular supply lending predisposition to ischemia in the setting of traumatic avulsion. Traction injuries can further create microsurgical difficulties given the limited supply and ill-defined collection of small vessels 14,15 . As a result, in cases of complete detachment, some opt to forgo reimplantation in light of other approaches to treatment in fear of futile effort and failure 15 .…”