Atypical replantation and reconstruction of frozen ear: A case report

Abstract

Rationale: The first successful ear replantation was performed by Pennigton in 1980 in Sydney. At least 84 ear replantations have been described in the literature over a period of 37 years since the first case. The authors have not found any previous case of frozen ear replantation in the literature.

Patient concerns: We report the case of a 38-year-old man, who had an injury to the head while working with a machine.

Diagnosis: The patient suffered total traumatic avulsion of the left ear. The ear was wrapped in moistened, sterile gauze and was transported on dry ice. At the time of admission to our department, the amputated ear was frozen to stiff, solid nonelastic matter.

Interventions: We attempted replantation. Despite repeated arterial thrombosis during surgery, the ear was successfully replanted with arterial and venous anastomosis.

Outcomes: Venous congestion occurred within 9 h of surgery and was treated using leeches. Freezing cold injury developed during reattachment. The radix and proximal parts of the helix exhibited necrosis and so were reconstructed by contralateral conchal cartilage graft, which was wrapped with a local subauricular skin flap. On completion of treatment, a satisfactory shape was achieved, although the replanted and reconstructed left auricle slightly was smaller than the contralateral auricle.

Lessons learned: Our report confirms that the replantation of a frozen, amputated ear is possible, and we suggest that ear replantation should be the method of choice for the treatment of ear loss even under these conditions.

Figure 1

Photographs demonstrating the preoperative status of the amputated left ear: A) viewed from the front, B) defect on the head, and C) viewed from the rear.

Figure 2

Photographs illustrating the course and complications of reattachment of the left auricle: A) appearance on the second postoperative day, B) appearance on the fifth postoperative day (venostatic crisis), C) appearance of the auricle 7 days after the delay operation, 3 weeks after replantation, and D) appearance of the left ear with a retroauricular flap before removing of a pedicle.

Figure 3

Photographs of reconstruction of the missing part of the lower third of the left auricle: A) image of the healthy right side, mirrored and overturned, B) the affected ear before the final operation, 9 months after replantation, C) appearance after implantation of the cartilaginous graft into the lower third of the auricle, and D) appearance of the ear after completion of the reconstruction operation.

Figure 4

Appearance of the ear 13 months after replantation and reconstruction of the auricle: A) left side view from the front, B) side view, and C) left side view from the back.