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

Abstract

Objectives: Traumatic amputation of the ear constitutes a great aesthetic deformity that can have a tremendous negative impact. Reports describing the survival of near-complete ear amputation using non-microsurgical replantation are scarce. We aimed to study the surgical outcome of patients with near-complete ear amputations supplied by small pedicle bridges that were treated with primary reattachment. Methods: We retrospectively studied patients with near-complete ear amputation who were admitted at Al Ain Hospital from January 2016 to December 2019. Results: Five patients were studied. The most common mechanism of injury was motor vehicle injury, followed by cutting injury. The skin pedicle was inferior in 3 (60%) patients of patients. The median width of the skin pedicles was 8.5 mm. The median interval between the injury and the surgical management was 4 hours. All patients underwent primary reattachment of the ear without microsurgery. One patient developed a small area of necrosis of the ear lobe. All patients recovered with a completely healed pinna and satisfactory overall appearance. Conclusions: Primary reattachment without microsurgery of the near-complete ear amputation can be safely performed in the presence of an intact skin pedicle. It can achieve an aesthetically satisfactory outcome without severe complications.

Auricular avulsion injuries

“…[ 3 7 ] Cases of amputated auricles with narrow pedicle bridges were inconsistently expressed in the literature as incomplete, near-complete, subtotal avulsion, and extended or deep laceration. [ 3 6 10 11 ] For the purpose of this review, we are going to describe ear injuries as complete and incomplete avulsion.…”

“…These include the size and the condition of the avulsed segment, the status of the adjacent skin, the mechanism of injury, the patient's comorbidities, availability of microsurgical techniques, and the surgeon's experience. [ 3 10 ]…”

“…DR of an incomplete ear avulsion (IEA), where a narrow skin pedicle is preserved, can be safely performed with a good outcome. [ 10 11 22 23 ] According to Erdmann et al ., an IEA can survive with DR as long as an attachment via the helical root is maintained. [ 2 ]…”

“…The addition of postoperative adjuvant therapy could augment the success rate of ear re-attachment by enhancing tissue perfusion. [ 10 11 24 30 ] A variety of postoperative treatments have been described in the literature. However, there is no consensus on the preference of one therapy over the other.…”

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

“…No need for pedicle examination for the artery or vein provided that an intact skin pedicle, good skin color, and active bleeding edges can be appreciated. These can be good prognostic findings suggesting good blood circulation [9]. In the literature, reattachment was done for several cases with superior pedicle ranged from 3mm to 15mm and inferior pedicle ranged from 5mm to 30mm Complications range from merely post-operative edema, venous congestion, epidermolysis, up to partial necrosis [7].…”