The management of auricular defect using retroauricular flap

Management of auricular defect is still a challenge for reconstructive plastic surgeons. The complexity of anatomy and shape will make the reconstruction complicated. It is also inevitable that choosing the right donor to close the defect that resembles the original contour is one of the success indicators of any ear reconstruction. There are wide selections of techniques for the management of auricular defect. Retroauricular flap is one of the best choices in auricular reconstruction due to its vascular richness, low of failure rate, similarity of tissue contour and the ease of closing the donor-site defect primarily. This article reported three cases of auricular defect with various causes: crushed injury, human bite, and tumor excision. Two stages of surgeries were performed on all three patients. After sufficient debridement, the ear defect is planted beneath retroauriculomastoid dermis. The second stage, three weeks from the first surgery, the donor flap is separated from it host. One week follow up after the second stage surgery, all of the post-operative wounds showed no signs of infection, minimal scar formation and has satisfied aesthetic outcomes. The retroauricular flap has the advantages of simple dissection, low failure rate and has a good shape, texture, color for a very good aesthetic results. This flap may be considered as a good solution in the management of auricular defect and a flap bank for ear reconstruction.

Reattachment of Partially Amputated Ear Based On 7 mm-wide Small Skin Pedicle without Vascular Anastomosis

PURPOSE: It has been reported that the ear perfusion can maintain by a very small pedicle because the ear has good vascularized system. Replantation of an amputated ear with vascular anastmosis, has been reported before and offers the succeessful reconstructive results. But, in this paper we report a case of complete nonmicrosurgical salvage of a nearly amputated ear based on 7 mm-wide small skin pedicle with adjunctive therapies. METHODS: A 49-year-old man was referred with a nearly complete detachment of left ear. The blood supply to the ear was maintained exclusively on 7 mm-wide small skin pedicle in the lobule. After we identified the fresh bleeding at the distal margin of the detached ear, we performed the primary repair. At the end of the procedure, the areas of the concha bowl and helical root appeared to be congested. So the immediate postoperative treatment for improving the tissue survival was done with Lipo-Prostaglandin E1 (Eglandin(R)) injection, leech apply and antibiotics medications. RESULTS: Assessment of the replanted ear on postoperative day 14 revealed a nearly viable auricle including the helical root. The ear appeared to be entirely healed, with excellent projection and fully restored normal elasticity. CONCLUSION: We found the complete salvage of a nearly amputated ear based on 7 mm-wide small skin pedicle with adjunctive therapies including Lipo-Prostaglandin E1 (Eglandin(R)) injection, leech apply and antibiotics without microsurgery.

Microsurgical Replantation of the Amputated Ear without Venous Repair: Clinical Experience with Leech

The application of microsurgical techniques to replant amputated ears has reliable outcome in ear salvage. However as the vessels available for anastomosis are relatively small, the technical success of the vascular repair is still challenging. In addition, avulsion amputations are a common occurrence and this makes ear vessels not available for use. Indeed, even when veins are identified and repaired or reconstructed, their relatively low flow state combined with postoperative swelling leads to a high rate of problems such as venous drainage. In these situations, either sticking the ear and allowing bleed freely or, more often, the leech therapy can be used as external decompression of the venous congestion in the replanted ear, which made the replantations successful. We present a successful result of microsurgical replantation in almost totally amputated ear which is anastomosed in the lower division of postauricular artery. No attempt was made to reestablish venous outflow microsurgically. Instead of venous repair, the leech therapy was applied immediately for the purpose of external decompression of postoperative venous congestion and the outcome was successful. This case provides the evidence that venous repair is not the requisite for successful replantation.

Microsurgical Replantation of the Amputated Ear without Venous Repair: Clinical Experience with Leech

The application of microsurgical techniques to replant amputated ears has reliable outcome in ear salvage. However as the vessels available for anastomosis are relatively small, the technical success of the vascular repair is still challenging. In addition, avulsion amputations are a common occurrence and this makes ear vessels not available for use. Indeed, even when veins are identified and repaired or reconstructed, their relatively low flow state combined with postoperative swelling leads to a high rate of problems such as venous drainage. In these situations, either sticking the ear and allowing bleed freely or, more often, the leech therapy can be used as external decompression of the venous congestion in the replanted ear, which made the replantations successful. We present a successful result of microsurgical replantation in almost totally amputated ear which is anastomosed in the lower division of postauricular artery. No attempt was made to reestablish venous outflow microsurgically. Instead of venous repair, the leech therapy was applied immediately for the purpose of external decompression of postoperative venous congestion and the outcome was successful. This case provides the evidence that venous repair is not the requisite for successful replantation.