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. 2020 Apr 14;5(3):381-389.
doi: 10.1002/lio2.372. eCollection 2020 Jun.

Auricular avulsion injuries and reattachment techniques: A systematic review

Andrew D Gailey  1 , Douglas Farquhar  2 , Joseph Madison Clark  2 , William W Shockley  2
Affiliations

Auricular avulsion injuries and reattachment techniques: A systematic review

Andrew D Gailey et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objectives: Multiple surgical techniques exist in the acute management of auricular avulsion injuries, including reattachment of the tissue as a composite graft, reconstruction using local skin flaps, the pocket principle, the Baudet method, and microvascular repair. This review aimed to compare the success rates of reattachment methods in auricular avulsion injuries.

Methods: A PubMed search systematically identified cases in which (a) an auricular avulsion injury occurred and (b) reattachment was attempted. Search results were combined with an extensive review of references from published studies. In total, 148 cases were identified. Three reviewers independently graded the final aesthetic result of each case using a 5-point scale. The average grade of each repair was compared to the reattachment method to identify successful techniques.

Results: Microvascular repair was associated with a statistically significant higher success rate compared to all other reattachment methods. Composite graft reattachment also tended to generate better final aesthetic outcomes, but this difference was not statistically significant.

Conclusion: Microvascular repair of the avulsed segment consistently demonstrated higher success rates. Composite graft reattachment should also be considered under the right circumstances. Overall, microvascular repair and composite graft reattachment should be considered the best options in cases of auricular avulsion repair. The authors share a major concern that other methods that rely on the use of periauricular skin will compromise any future attempts for secondary reconstruction, such as staged procedures using costal cartilage grafts. Manipulation of these tissues and in particular burying of the avulsed ear cartilage is discouraged.

Level of evidence: 4.

Keywords: Baudet method; auricular avulsion; auricular avulsion injury; ear avulsion; microsurgical repair; microvascular repair; periauricular skin; platysma myocutaneous flap; pocket principle; temporoparietal fascia flap.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA diagram demonstrating the screening and inclusion/exclusion processes
Figure 2
Figure 2
Frequency of auricular avulsion injuries by cause (top) and by degree of injury (bottom)
Figure 3
Figure 3
Final average grade and repair technique employed. TPF flap, temporoparietal fascia flap
See this image and copyright information in PMC

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