Auricular avulsion injuries: Literature review and management algorithm

Abstract

Traumatic ear avulsion (TEA) may have tremendous psychological consequences if not managed properly. There are no clear guidelines on the surgical management of these injuries, especially in developing countries where microsurgical facilities are lacking. We aimed to review the literature on surgical management of TEA with the main focus on direct re-attachment (DR) so as to develop a surgical management algorithm that can be applied in the absence of microsurgical facilities. We performed an extensive review of the relevant English literature on papers indexed in PubMed describing TEA repaired with DR without restriction to a specific publication time window. A total of 28 cases in 18 publications were reviewed and analyzed. Our results indicate that in the acute setting with no available microvascular expertise, DR of auricular avulsion injuries can be better than other nonmicrosurgical techniques in generating good esthetic results, especially in incomplete auricular avulsion and small segment avulsion. The operative approach depends on the clinical setting. DR of the auricular avulsion injuries is an accepted approach. It produces good cosmetic outcomes while preserving the auricular area for future reconstruction in case of re-attachment failure.

Keywords: Direct attachment; ear amputation; ear avulsion; injury; review; surgery.

Figure 1

A 34-year-old man sustained injured by a large piece of glass that slipped on his head and sustained a incomplete amputation of his left ear. The ear remained attached by a 10-mm strip of skin at the level of the tragus (a). Direct postoperative view following a three-layer direct re-attachment of the ear (b). The patient developed ear edema which subsided and the ear survived (Courtesy of Dr. Mauro D’Arcangelo, Consultant Plastic Surgeon, Tawam Hospital, Al-Ain, United Arab Emirates)

Figure 2

A 31-year-old man sustained an incomplete right ear amputation following a quad bike accident (a). The ear appeared well perfused 7 days post direct re-attachment (b). Two-year postoperative view with essentially healthy appearance of the ear (c) (Courtesy of Dr. Mauro D’Arcangelo, Consultant Plastic Surgeon, Tawam Hospital, Al-Ain, United Arab Emirates)

Figure 3

A 25-year-old man sustained a complete amputation of the upper third of the right ear involving the entire helix after being assaulted and bitten by another man; the amputated segment is shown after 1 h of separation from the body (a). Direct postoperative view following re-attachment of the ear (b). On postoperative day 4, the replanted ear appeared well perfused, bleeding at needle prick, and persistent venous congestion (c) (Courtesy of Dr. Mauro D’Arcangelo, Consultant Plastic Surgeon, Tawam Hospital, Al-Ain, United Arab Emirates)

Figure 4

A developed algorithm for surgical management of traumatic auricular avulsion injuries in the acute settings depending on the degree of the avulsion, size of the amputated segment, and availability of microsurgery facility and expertise. HBOT: Hyperbaric oxygen therapy