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

ABSTRACT

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.