Salvage of a failed auricle replant with a temporoparietal fascia and subgaleal fascia flaps

Abstract

Abstract.A case of total anricle amputation is described in which microvascular replantation was attempted. A combined temporoparietal fascia and subgaleal fascia flap was planned as a lifeboat to preserve the cartilage skeleton of the ear, should the replant fail, as it indeed happened. The salvage procedure was done in the immediate postoperative period, with a long term acceptable result. The available options, along with other theoretical approaches to this problem, are discussed. Key words: Ear replantation -Temporoparietal fasciaSubgaleal fascia -Ear reconstructionTreatment of avulsed auricles remains a challenge. The treatment of choice depends mainly on the size of the avulsed part [10]. For major avulsions, total or near-total revascularization, either direct or indirect, should be performed in order to preserve as much of the ear as possible.A case of total auricle avulsion is reported, in which microvascular replantation was attempted, and temporoparietal fascia (TPF) and subgaleal fascia (SGF) flaps were used to preserve the cartilaginous framework in the face of a failed replantation. Case reportA 68-year-old male, type II diabetic, was admitted with a total avulsion of the right auricle (Fig. 1). Examination of the amputated structure disclosed sizable vessels, and the patient was considered a candidate for microvascular replantation, with an awareness of the limited chances of success as reported in the literature for this type of replantation. Should the replant fail, the possibility of a salvage procedure, such as a temporoparietal fascia (TPF) flap for covering the cartilaginous frame, was considered. The surgery was performed using local anesthesia and IV sedation. An artery in the lower pole of the ear was anastomosed end-to-end to the posterior auricular artery. No sizable veins were found suitable Correspondence to: RC. Cavadas, Facultades 1 C-10, E-46021 Valencia, Spain within the amputated part, so the venous egress was reconstructed by means of an end-to-end anastomosis between an artery of the upper pole of the ear and a vein of the scalp. Intravenous low molecular weight dextran was initiated on completion of the arterial repair.Four hours postoperative, an arterial thrombosis was diagnosed and the patient was returned to the operating room, where the artery distal to the anastomosis was found to be diffusely thrombosed within the auricle. There was no question of anastomosis revision and the ear was detached. Under local anesthesia and IV sedation, a TPF flap was elevated as was a subgaleal fascia (SGF) flap (Fig. 2). The auricle was skeletonized and the cartilaginous frame was sutured in position (Fig. 3). The TPF flap was turned over to provide cover to the anterolateral aspect of the frame. The SGF flap was used to cover the posteromedial aspect, and the remaining SGF was gathered in the retroanricular area to give projection to the reconstructed ear (Fig. 4). The remainder of the lobule was folded up to the lower pole of the frame. A thick partial skin graft over both aspects of th...

Supramicrosurgical Ear Replantation: Case Report

“…Nonmicrosurgical treatments yield relatively modest results, compared to a successful microsurgical replantation, but are technically easier and do not carry the potential morbidity of postoperative venous congestion and significant bleeding. 1,2 The technique described by Pribaz et al 1 is particularly appealing for segmental amputations of the auricle, when formal microvascular replantation is particularly difficult. The role of the temporoparietal fascia flap for coverage of the cartilage skeleton of the amputated ear has not been well defined.…”

“…The role of the temporoparietal fascia flap for coverage of the cartilage skeleton of the amputated ear has not been well defined. 2 Most ear amputations, either complete or segmental, are caused by avulsive mechanisms, which cause extensive vessel damage. This, and the fact that the ear has very thin vessels, account for the reportedly discouraging results of attempts at replantation.…”

“…Basically, there are two ways of treating a completely severed ear, namely, microvascular replantation or some kind of composite grafting. 1,2 Microvascular ear replantation has been rarely reported in the literature, with barely over 20 cases described. Although a successful replantation gives a result far superior to other treatments, it is technically very demanding, and attention should be paid to many details for a successful result.…”