Microsurgical ear replantation without venous repair: Failure of development of venous channels despite patency of arterial anastomosis for 14 days

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.