M. Akyurek et al., Microsurgical ear replantation without venous repair: Failure of development of venous channels despite patency of arterial anastomosis for 14 days, ANN PL SURG, 46(4), 2001, pp. 439-442
The authors describe a case of microvascular ear replantation with repair o
f the artery only and medicinal leech therapy that survived for 14 days but
ultimately failed as a result of the absence of development of venous chan
nels between the replant and the recipient bed. A 35-year-old man presented
with complete avulsion of 80% of the right external ear. The auricle was r
evascularized successfully via transposition of the superficial temporal ar
tery (STA) and end-to-end anastomosis between the STA and an identified art
erial branch on the posterior surface of the ear, using the technique of lo
ngitudinal wedge resection, No suitable veins could be found, therefore med
icinal leech therapy was used for venous drainage as well as for systemic h
eparinization. Although the replant remained viable. frequency of leeching
did not decrease over 2 weeks. On postoperative day 14, despite obvious via
bility of the replanted ear, leeching was stopped, considering the ongoing
blood loss. Unfortunately, the auricle was found to be necrosed totally the
following day. In retrospect, the authors think that inadequate debridemen
t of nonvital tissues may have led to the failure of development of venous
channels between the replant and the recipient bed, as manifested by the fr
equent requirement of leeching to relieve venous congestion long after reva
scularization. They conclude that the importance of thorough debridement ca
nnot be overemphasized in microsurgical ear replantation with no vein anast
omosis, as demonstrated in their patient. From the point of view of creatio
n of venous drainage channels, deepithelialization of the posterior ear ski
n may be beneficial.