Anterior approach to posterior auricular artery in microvascular anastomosis - a new concept in replanting amputated ears - experience from four successful cases and literature review.

INTRODUCTION: Auricular amputation is rare but devastating to the patient's aesthetics and psychology. Only about 60 cases of successful microsurgical replantation were reported in the literature. There is currently no complete procedure for auricular replantation, including a recommended operating position.

MATERIALS AND METHODS: Four cases of microsurgical auricular replantation from February 2012 to July 2022 were studied. Data included age, cause, duration of ischemia, patient position, sequence of vascular anastomosis, method of arterial/venous anastomosis/grafting, amount of blood transfused, total surgical time, and results.

RESULTS: The most frequent causes were traffic accidents (3 cases) followed by violent incidents (1 case). The duration of ischemia ranged from 4 to 14 hours. The supine position and anterior observation for anastomosis were chosen in all cases. All recipient arteries were the posterior auricular artery (diameter 0.4-0.5 mm). Veins were difficult to find, and vein anastomosis could not be achieved in two patients, in which case, leeches for 10-14 days. Blood transfusion volume ranged from 3 to 4 units.

CONCLUSION: An amputated ear is a rare injury. Microsurgical auricular replantation is the optimal choice with unparalleled aesthetic results. The choice of recipient artery is usually branches of the posterior auricular artery. If the vein is anastomosed, the results would be optimal, else chemical or biological leeches are required to treat venous congestion.