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Baldini N. A comparison of ear amputations replantation techniques. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023:101497. [PMID: 37178870 DOI: 10.1016/j.jormas.2023.101497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/12/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The management of traumatic ear amputations remains a rare and difficult occurrence for surgeons. This is due to the fact that the chosen replantation technique must ensure the best vascular supply and the surrounding tissues have to be preserved as to not jeopardize a future auricular reconstruction in the event of replantation failure. OBJECTIVE This study aimed to review and synthesize the literature about the different surgical techniques described to date in the management of traumatic ear amputations (partial or total). MATERIALS AND METHODS Relevant articles were searched on PubMed, ScienceDirect, and Cochrane Library databases in accordance with the PRISMA statement guidelines. RESULTS A total of 67 articles was retained. When possible, microsurgical replantation enabled the best cosmetic result but required important care. CONCLUSION Pocket techniques and local flaps should not be performed because of the lower cosmetic result and the use of the surrounding tissues. However, they could be reserved for patients without access to advanced reconstructive techniques. When possible, microsurgical replantation can be attempted after patient consent for blood transfusions, postoperative care and hospital stay. Simple reattachment for earlobe amputations and ear amputations up to one third is recommended. When microsurgical replantation cannot be attempted, and if the amputated segment is viable and bigger than one third, simple reattachment may be attempted with an increased risk of replantation failure. In case of failure, an auricular reconstruction by an experienced microtia surgeon or prosthesis may be considered.
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Affiliation(s)
- Nicolas Baldini
- Facial Plastic & Maxillofacial Surgery, M.D., University of Bordeaux College of Health Sciences, Bordeaux, France; Anatomy Laboratory, University of Bordeaux College of Health Sciences, Bordeaux, France.
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Baldini N. A Comparison of Ear Amputations Replantation Techniques. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023:101429. [PMID: 36871668 DOI: 10.1016/j.jormas.2023.101429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND The management of traumatic ear amputations remains a rare and difficult occurrence for surgeons. This is due to the fact that the chosen replantation technique must ensure the best vascular supply and the surrounding tissues have to be preserved as to not jeopardize a future auricular reconstruction in the event of replantation failure. OBJECTIVE This study aimed to review and synthesize the literature about the different surgical techniques described to date in the management of traumatic ear amputations (partial or total). MATERIALS AND METHODS Relevant articles were searched on PubMed, ScienceDirect, and Cochrane Library databases in accordance with the PRISMA statement guidelines. RESULTS A total of 67 articles was retained. When possible, microsurgical replantation enabled the best cosmetic result but required important care. CONCLUSION Pocket techniques and local flaps should not be performed because of the lower cosmetic result and the use of the surrounding tissues. However, they could be reserved for patients without access to advanced reconstructive techniques. When possible, microsurgical replantation can be attempted after patient consent for blood transfusions, postoperative care and hospital stay. Simple reattachment for earlobe amputations and ear amputations up to one third is recommended. When microsurgical replantation cannot be attempted, and if the amputated segment is viable and bigger than one third, simple reattachment may be attempted with an increased risk of replantation failure. In case of failure, an auricular reconstruction by an experienced microtia surgeon or prosthesis may be considered.
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Affiliation(s)
- Nicolas Baldini
- Facial Plastic & Maxillofacial Surgery, University of Bordeaux College of Health Sciences, Bordeaux, France.
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Pertea M, Ciobanu P, Poroch V, Velenciuc N, Lunca S, Anghelina F, Palade DO. Arterial only anastomosis associated with modified Baudet technique in ear replantation: Case reports and literature review. Medicine (Baltimore) 2021; 100:e25357. [PMID: 33787638 PMCID: PMC8021351 DOI: 10.1097/md.0000000000025357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/11/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Total ear amputation is a relatively rare trauma with an absolute indication for surgical treatment. Numerous techniques for auricular reconstruction have been described. When local and general conditions allow microsurgical replantation, this must be the first choice. We propose the association of microsurgical techniques with some modification (modified Baudet technique) to obtain higher survival rate of the reimplanted stump. METHODS This study included cases of 3 male patients with total ear amputation, the injuries and their mechanism (workplace accident) being identical. Chief complaints were pain, bleeding, important emotional impact due by an unaesthetic appearance. The established diagnosis was traumatic complete ear amputation (grade IV auricular injury according to Weerda classification). Microsurgical replantation was performed only with arteriorraphy, and no vein anastomosis. Cartilage incisions and skin excisions were made to enlarge the cartilage-recipient site contact area. Medicinal leeches were used to treat venous congestion, to which systemic anticoagulant therapy was added. RESULTS The results showed the survival of the entire replanted segment in all cases, with good function and esthetical appearance. Patients were fully satisfied with the final outcome. CONCLUSION Microsurgical replantation is the gold standard, for the surgical treatment of total ear amputation. We believe that cartilage incisions and the increased surface of contact between cartilage and recipient site has an adjuvant role in revascularization of the amputated stump (with only arterial anastomosis) and the use of hirudotherapy helps to relieve early venous congestion.
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Affiliation(s)
- Mihaela Pertea
- University of Medicine and Pharmacy “Grigore T Popa”
- Clinic of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency Hospital
| | - Petru Ciobanu
- University of Medicine and Pharmacy “Grigore T Popa”
- Clinic of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency Hospital
| | - Vladimir Poroch
- University of Medicine and Pharmacy “Grigore T Popa”
- Clinic of Palliative Care
| | - Natalia Velenciuc
- University of Medicine and Pharmacy “Grigore T Popa”
- Second Surgical Oncologic Clinic, Regional Institute of Oncology
| | - Sorinel Lunca
- University of Medicine and Pharmacy “Grigore T Popa”
- Second Surgical Oncologic Clinic, Regional Institute of Oncology
| | | | - Dragos Octavian Palade
- University of Medicine and Pharmacy “Grigore T Popa”
- Clinic of Otorhinolaringology, “Sf. Spiridon” Emergency Hospital, Iasi Romania
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Leeching as Salvage Venous Drainage in Ear Reconstruction: Clinical Case and Review of Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 6:e1820. [PMID: 30881774 PMCID: PMC6414113 DOI: 10.1097/gox.0000000000001820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/16/2018] [Indexed: 11/26/2022]
Abstract
Background Ear avulsion is a rare complication of different traumas, such as car accidents, human or animal bites and stab wounds, and can result in dramatic cosmetic consequences for the patient. Ear replantation, revascularization, and reattachment are the options offering best aesthetic results. But venous outflow insufficiency is responsible for a high rate of failures. Leeching is one the most efficient methods to relieve venous congestion. It has been used as an alternative venous outflow in case of severe impairment of the physiologic one. Methods We present a case of successful rescue of a congested reattached ear by leeching after subtotal avulsion, along with a review of the literature on cases of avulsed auricle reconstruction salvaged by hirudotherapy. Data were collected and analyzed to identify a best regimen to deal with venous congestion. Results More than 130 cases of avulsed auricle savage are described in the literature, in a fourth of which leech therapy was used in the management of venous congestion. Discussion In case of both venous outflow deficit or absence, leeches are a potentially successful option to correct the congestion while new veins reestablish normal physiology. The need for anticoagulant/antiaggregant therapy, antibiotics, and often blood transfusion are the main pitfalls of leeching. Conclusion Leeches can be considered a salvage method for ear replantation and reattachment in those cases that lack venous outflow in the presence of valid arterial inflow.
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Momeni A, Liu X, Januszyk M, Wan DC, Buncke GM, Buntic RF, Parrett BM. Microsurgical ear replantation-is venous repair necessary?-A systematic review. Microsurgery 2015; 36:345-50. [DOI: 10.1002/micr.22411] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/11/2015] [Accepted: 03/17/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Arash Momeni
- Division of Plastic and Reconstructive Surgery; Stanford University Medical Center; Palo Alto CA
| | - Xiangxia Liu
- Division of Plastic and Reconstructive Surgery; Stanford University Medical Center; Palo Alto CA
| | - Michael Januszyk
- Division of Plastic and Reconstructive Surgery; Stanford University Medical Center; Palo Alto CA
| | - Derrick C. Wan
- Division of Plastic and Reconstructive Surgery; Stanford University Medical Center; Palo Alto CA
| | - Gregory M. Buncke
- California Pacific Medical Center; The Buncke Clinic; Division of Microsurgery; San Francisco CA
| | - Rudolf F. Buntic
- California Pacific Medical Center; The Buncke Clinic; Division of Microsurgery; San Francisco CA
| | - Brian M. Parrett
- California Pacific Medical Center; The Buncke Clinic; Division of Microsurgery; San Francisco CA
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Sinwar PD. Auricle injury due to human bite – A rare case report and review literature. Int J Surg Case Rep 2015; 6C:5-7. [PMID: 25485846 PMCID: PMC4337930 DOI: 10.1016/j.ijscr.2014.11.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 11/19/2014] [Accepted: 11/19/2014] [Indexed: 11/30/2022] Open
Abstract
Traumatic auricular amputation due to human bite is not a common event. Human bites are as serious as animal bites because they induce a higher incidence of infectious complications. The traumatic loss of an ear constitutes a great esthetic deformity and considerably affects the patient's psychology.
Traumatic auricular amputation due to human bite is not a common event. Bite wounds are always considered to be complex injuries contaminated with unique poly-microbial inoculum. Human bites are as serious as animal bites because they induce a higher incidence of infectious complications. In bite wounds to the face, infectious complications can create more difficulties than the initial tissue damage itself for the task of restoring an esthetic appearance. In this case report a young male patient had ear lobule injury on interpersonal violence and amputation of ear lobule results. Due to delay in presentation and high chances of infection wound healing by secondary intention achieved.
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Momeni A, Parrett BM, Kuri M. Using an unconventional perfusion pattern in ear replantation-arterialization of the venous system. Microsurgery 2014; 34:657-61. [DOI: 10.1002/micr.22308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 07/26/2014] [Accepted: 07/31/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Arash Momeni
- Division of Plastic and Reconstructive Surgery; Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, CA 94304
| | - Brian M. Parrett
- The Buncke Clinic, California Pacific Medical Center; San Francisco CA
| | - Mauricio Kuri
- The Buncke Clinic, California Pacific Medical Center; San Francisco CA
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Characterization of the digestive tract microbiota of Hirudo orientalis (medicinal leech) and antibiotic resistance profile. Plast Reconstr Surg 2014; 133:408e-418e. [PMID: 24572887 DOI: 10.1097/01.prs.0000438461.06217.bb] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND There are at least three distinct European leech species used medicinally: Hirudo medicinalis, H. orientalis, and H. verbana. Infection caused by leech microbiota is the most widely reported complication. Few studies have reported the culturable and unculturable bacteria and examined the antibiotic resistances in H. orientalis. METHODS Following stratified random sampling from a major worldwide leech supplier, Hirudo orientalis leeches were identified by visual comparison and amplification and sequencing the cox1 locus. Combined culture and culture-independent approaches were used to characterize the microbiota of the midgut, and bacterial gyrB sequences from distinct colonies were used to identify the Aeromonas isolates. Nonculturable studies involved clone libraries of 16S rRNA genes, and Etests were used to investigate antibiotic sensitivities. RESULTS Analysis of 16S rRNA gene clone libraries revealed the presence of several species in the intraluminal fluid of the crop, including a new finding of Morganella morganii, with Rikenella-like (35 percent) and Aeromonas veronii (38 percent) dominant members. The intestinum contained bacteria not previously isolated from the leech: Magnetospirillium species and Roseospira marina. Etests showed all A. veronii isolates were sensitive to ciprofloxacin, with either a complete or intermediate resistance to Augmentin. CONCLUSIONS The authors show diverse microbiota in the leech digestive tract. The pathogenic potential of the additional gut symbionts isolated in this study is yet to be elucidated; however, M. morganii, which is a known human pathogen, is a new finding. In addition to adding to the knowledge base regarding antibiotic sensitivities, this article serves as an update to the reconstructive surgeon regarding leech therapy.
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Mommsen J, Rodríguez-Fernández J, Mateos-Micas M, Vázquez-Bouso O, Gumbao-Grau V, Forteza-Gonzalez G. Avulsion of the auricle in an anticoagulated patient: is leeching contraindicated? A review and a case. Craniomaxillofac Trauma Reconstr 2012; 4:61-8. [PMID: 22655116 DOI: 10.1055/s-0031-1279668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Amputation of the auricle is a periodic occurrence leading to disfigurement if not treated properly. Venous stasis is a common complication in reattachments and requires decongestant and anticoagulant treatment. Today, leech therapy is the treatment of choice. Common problems are that it is not available everywhere and that it is usually contraindicated in anticoagulated patients. The peculiarities of leech therapy and the various aspects of surgical management are reviewed. A case of a partial amputation of the auricle in a patient under concomitant anticoagulation therapy with warfarin is presented. The amputated part was reattached in another hospital without microvascular anastomosis. The patient presented to our department with early signs of venous congestion. Leech therapy was started 35 hours after trauma, and the patient continued his anticoagulation therapy. With this treatment, 90% of the amputated part was rescued. The anticoagulation therapy of the patient may have played an important role in the first hours after reattachment, preventing capillary thrombosis and in consequence facilitating the minimal oxygenation necessary. The claim that anticoagulation therapy is a contraindication to leeching should be questioned in cases of reattachments in well-controllable locations without arterial anastomosis.
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Affiliation(s)
- Jens Mommsen
- Hospital Universitari Joan XXIII, Cirugía Maxilofacial, Tarragona, Spain
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Wong W, Wilson P, Savundra J. Total ear replantation using the distal radial artery perforator. J Plast Reconstr Aesthet Surg 2010; 64:677-9. [PMID: 20598953 DOI: 10.1016/j.bjps.2010.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 06/08/2010] [Indexed: 10/19/2022]
Abstract
We present a case of total ear replantation where the ear was initially perfused on a perforator vessel from the radial artery prior to replantation using the radial artery as a donor vessel.
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Affiliation(s)
- W Wong
- Department of Plastic & Maxillofacial Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
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Schlaudraff KU, Bezzola T, Montandon D, Pepper MS, Pittet B. Mixed Arterio-Venous Insufficiency in Random Skin Flaps in the Rat: Is the Application of Medicinal Leeches Beneficial? J Surg Res 2008; 150:85-91. [DOI: 10.1016/j.jss.2008.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 12/10/2007] [Accepted: 01/10/2008] [Indexed: 11/30/2022]
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Kyrmizakis DE, Karatzanis AD, Bourolias CA, Hadjiioannou JK, Velegrakis GA. Nonmicrosurgical reconstruction of the auricle after traumatic amputation due to human bite. Head Face Med 2006; 2:45. [PMID: 17140448 PMCID: PMC1693551 DOI: 10.1186/1746-160x-2-45] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Accepted: 12/01/2006] [Indexed: 11/30/2022] Open
Abstract
Background Traumatic auricular amputation due to human bite is not a common event. Nonetheless, it constitutes a difficult challenge for the reconstructive surgeon. Microsurgery can be performed in some cases, but most microsurgical techniques are complex and their use can only be advocated in specialized centers. Replantation of a severed ear without microsurgery can be a safe alternative as long as a proper technique is selected. Methods We present two cases, one of a partial and one of a total traumatic auricular amputation, both caused by human bites, that were successfully managed in our Department. The technique of ear reattachment as a composite graft, with partial burial of the amputated part in the retroauricular region, as first described by Baudet, was followed in both cases. Results and discussion The prementioned technique is described in detail, along with the postoperative management and outcome of the patients. In addition, a brief review of the international literature regarding ear replantation is performed. Conclusion The Baudet technique has been used successfully in two cases of traumatic ear amputation due to human bites. It is a simple technique, without the need for microsurgery, and produces excellent aesthetic results, while preserving all neighboring tissues in case of failure with subsequent need for another operation.
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Affiliation(s)
- Dionysios E Kyrmizakis
- Department of Otolaryngology, University of Crete, School of Medicine, Heraklion, Crete, Greece
| | - Alexander D Karatzanis
- Department of Otolaryngology, University of Crete, School of Medicine, Heraklion, Crete, Greece
| | | | - John K Hadjiioannou
- Department of Otolaryngology, University of Crete, School of Medicine, Heraklion, Crete, Greece
| | - George A Velegrakis
- Department of Otolaryngology, University of Crete, School of Medicine, Heraklion, Crete, Greece
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Abstract
Microvascular ear replantation is a rare event, having been reported only 25 times since the first case in 1980. It requires a lengthy operative time and hospital stay, results in multiple blood transfusions, and has a significant failure rate. Nevertheless, a successful ear replantation is a dramatic demonstration of the power of microsurgery to restore a lost part. When successful, it obviates the need for other complex reconstructive efforts and provides an unsurpassed aesthetic result. This article reviews the history of microsurgical and nonmicrosurgical ear replantation and presents recommendations for treatment.
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Affiliation(s)
- Gabriel M Kind
- The Buncke Clinic, California-Pacific Medical Center, and University of California at San Francisco, 94114, USA.
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Abstract
Most trauma to the ear is minimal and can heal with excellent results if meticulous repair is performed immediately after the accident. Amputation of the ear, on the other hand, is a very serious problem and can lead to severe deformity. Many reattachment and reconstruction techniques are described; however, reattachment of the severed ear continues to be a major challenge that can lead to severe deformity. To date, only a few successful cases of microvascular ear replantation have been reported. Bone-anchored prosthesis or plastic reconstruction may be recommended if the patient refuses surgery, in patients with multiple health problems, or in the case of a reconstructive attempt that has failed and the patient prefers to wear a prosthesis for the rest of his or her life.
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the indications and contraindications for extremity replantation. 2. Outline the sequence and technique of replantation. 3. Identify potential complications of replantation and recognize treatment options. 4. Assess the results of replantation in terms of function and costs versus benefits.
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Affiliation(s)
- W C Pederson
- Hand Center of San Antonio, Department of Surgery and Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, Texas, USA.
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