Microvascular ear replantation

Plastic surgeons have long shown an interest in and the ability to reconstruct defects of the external ear. As the size of the defect becomes larger, the reconstructive effort becomes greater, and may involve multiple stages with significant potential donor site morbidity. In the setting of traumatic ear loss, the occasional successful replantation of parts of the car as a composite graft is well documented [8,13,14,22,40]. The advent of microsurgery provided another option when dealing with traumatic car amputation. Although Buncke and Schulz established the technical details surrounding microvascular ear replantation in 1964 [5], it was not until 1980 that Pennington et al. reported the first successful clinical case [34]. In 1996, the author reviewed the English language surgical literature and found 13 other cases of successful ear replantation, only four of which were total amputations [20]. A current review shows that, including those from earlier series, there have been a total of only 25 cases reported since 1980 (Table 1). The rarity of ear replantation is likely caused by a number of factors. Isolated traumatic ear amputation is an uncommon event, and frequently occurs in conjunction with major systemic or head and neck trauma, which by itself usually precludes an attempt at replantation. In those few cases in which it is attempted, microvascular ear replantation is a significant challenge because of the small size of the vessels and the fact that there is frequently an avulsion component to the amputation, extending the zone of trauma and making primary repair of the injured vessels unlikely, Venous congestion occurs to some extent in nearly every case and remains the most common cause of postreplantation complications.