Successful Replantation of a Severed Half Ear

McDowell, Frank

doi:10.1097/00006534-197109000-00018

Cited by 31 publications

(12 citation statements)

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“…Only small pieces of auricle will survive as composite grafts when sutured back in place. Successful microvascular replantation of amputated ears has infrequently been reported [7,9,12], due to the small size of the vessels within the part, and the avulsive nature of the trauma. Frequently, what initially seems to be a successful replant, becomes congested and eventually fails.…”

Section: Discussionmentioning

confidence: 99%

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

Cavadas

1997

Eur J Plast Surg

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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...

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Section: Discussionmentioning

confidence: 99%

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

Cavadas

1997

Eur J Plast Surg

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“…The distance between the free borders and the graft was said to be less than 1 cm. [1][2][3][4][5]24 The cases which could be reconstructed as composite graft and their success rates were low. Musgrave and Garrett 25 indicated the decreased viability of the amputated ears, which were adapted as composite grafts, contrary to the literature implying viability of composite tissues smaller than 2 cm.…”

Section: Alagöz Et Almentioning

confidence: 99%

“…The most ancient method of these is to adapt the part into its original place as a composite graft. [1][2][3][4][5] The deepithelization of the amputated part and replacement into the pockets formed in the mastoid, cervical, or forearm region are the first steps of staged transfer of the amputated part to its original place. 5 Another method is to cover the auricular cartilage with the grafted temporoparietal fascia flap.…”

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confidence: 99%

A New Method in the Treatment of Ear Amputation

Alagöz

Uysal²,

İşgören³

et al. 2007

Annals of Plastic Surgery

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There have been plenty of reconstruction methods for ear amputation, and replantation preserves its importance. In situations where replantation is not feasible, various methods were proposed. We indicate an alternative technique for the ear amputation without replantation indication. The method of replacing of a vascular structure into the tunnel formed on the posterior side of the amputated ear was used instead of replacing the ear cartilage into a vascular area that was described in the literature of ear prefabrication. The dorsal fascial flaps which were prepared from the back of 10 New Zealand rabbits were placed into the amputated ear. The 2 groups, control and the experimental, were consequently the ear that was adapted as a composite graft and the ear with the flap inserted. The ears were examined macroscopically and photographed on postoperative days 3, 7, 14, and 21. On the 21st day, the nourishment pattern of the ear, the dorsal fascia, and the dorsal fascia adapted ear were investigated with digital subtraction angiography (DSA). The group that received applied dorsal fascia possessed increased vascularity. The viability was evaluated with the biopsies taken from the control group and the group that received applied dorsal fascial flap on the 21st day. The cartilage and the connective tissue were viable in the flap-applied group, whereas there was necrosis in the control group. The reflection of the experimental study was performed on 2 subtotal and 1 total ear amputation cases, with the utilization of the superficial temporal artery. The nourishment of the flaps was evaluated with postoperative photographs, angiography, and bone scintigraphy.

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“…Über der angegebenen Größe steigt die Verlustrate auf über 50% an. Trotzdem wurde über erfolgreiche nichtmikrochirurgische Replantationen von Ohranteilen mit bis zu 30 mm Durchmesser berichtet [18,22,28,45].…”

Section: Replantationsverfahrenunclassified

“…Viele Replantate zeigen nach dem ersten Verbandswechsel Zyanose bis hin zur Blasenbildung, überleben dennoch bei korrekter Behandlung -Zitat von Byars: "Every composite graft looks dead at the first dressing" - [10,11,15,19,28].…”

Section: Replantationsverfahrenunclassified

Ohrmuschelverletzungen - Klassifizierung und Therapiekonzept

et al. 2001

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The treatment of traumatic defects of the auricle concerning the exact reconstruction of details and aesthetic aspects is exacting for the surgeon. To face the expectations towards best trauma care, the different locations and extent of auricular injuries should be included in the different therapeutic strategies. The insufficient treatment results in mostly difficult secondary conditions. We present a classification for ear traumas, which considers size and location of defects. Depending on this, different techniques and methods of reconstruction are recommended. Advantages and disadvantages are pointed out and discussed with several examples and with the present literature.

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Successful Replantation of a Severed Half Ear

Cited by 31 publications

References 0 publications

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

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

A New Method in the Treatment of Ear Amputation

Ohrmuschelverletzungen - Klassifizierung und Therapiekonzept

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