Ear Amputation Research Articles

Temporoparietal Fascia Sandwich Technique in the Immediate Reconstruction of Human Bite Ear Amputation.

Traumatic ear amputation is a rare injury. Ear replantation is the gold standard in dealing with amputated ears. However, this is not always feasible. In this case series, the authors discuss the immediate reconstruction of traumatic ear amputation using temporoparietal fascia with the same skin from the amputated ear, which provided a high esthetic result and patient satisfaction. The authors present a case series of 3 patients from July 2018 to May 2020 who suffered from traumatic ear amputation due to a human bite and were successfully reconstructed using temporoparietal fascia and the same skin from the amputated ear as FTSG.The cartilage was sutured back, the temporoparietal fascia was raised and flipped over the exposed cartilage, and the FTSG previously harvested from the same amputated ear was put on the fascia. Quilting sutures were taken to ensure proper inset of the graft on the fascia. The authors measured the patient-reported outcome using an Ear-Q validated questionnaire. All patients were males, with a mean age of 30.6 years. They were all smokers, and none of them had any comorbidities. No major complications occurred. However, partial graft loss occurred in one patient and healed properly with secondary intention. All patients had high satisfaction scores of more than 70 in the EAR-Q questionnaires. Traumatic human bite ear amputations can be reconstructed with good esthetic outcomes by using single-stage temporoparietal fascia and the same skin of the amputated ear as a full-thickness skin graft whenever replantation is not feasible.

A comparison of ear amputations replantation techniques

BackgroundThe management of traumatic ear amputations remains a rare and difficult occurrence for surgeons. This is due to the fact that the chosen replantation technique must ensure the best vascular supply and the surrounding tissues have to be preserved as to not jeopardize a future auricular reconstruction in the event of replantation failure. ObjectiveThis study aimed to review and synthesize the literature about the different surgical techniques described to date in the management of traumatic ear amputations (partial or total). Materials and methodsRelevant articles were searched on PubMed, ScienceDirect, and Cochrane Library databases in accordance with the PRISMA statement guidelines. ResultsA total of 67 articles was retained. When possible, microsurgical replantation enabled the best cosmetic result but required important care. ConclusionPocket techniques and local flaps should not be performed because of the lower cosmetic result and the use of the surrounding tissues. However, they could be reserved for patients without access to advanced reconstructive techniques. When possible, microsurgical replantation can be attempted after patient consent for blood transfusions, postoperative care and hospital stay. Simple reattachment for earlobe amputations and ear amputations up to one third is recommended. When microsurgical replantation cannot be attempted, and if the amputated segment is viable and bigger than one third, simple reattachment may be attempted with an increased risk of replantation failure. In case of failure, an auricular reconstruction by an experienced microtia surgeon or prosthesis may be considered.

RECONSTRUCTION OF POST-TRAUMATIC DEFECTS OF THE EXTERNAL EAR AND NOSE WITH AUTOLOGOUS COSTAL CARTILAGE

Traumatic ear amputation and post-traumatic nose defect are aesthetic deformities that can have negative consequences (lead to psychological trauma), leading to a change in the quality of life. The presented clinical case describes a protocol for the reconstruction of a partially amputated defect of the external ear and nose, which required various surgical steps; including the removal of cartilage from the ribs, followed by the creation of a cartilaginous model of the ear, the introduction of its subcutaneous region behind the ear, taking into account the anatomy of the outer ear as much as possible. The second stage after 1.5 months is the restoration of the amputated ear area with a combined superficial temporal fascial flap, costal cartilage with suturing to the amputated part of the ear and dorsal rhinoplasty using modeling costal autocartilaginous flap. The postoperative result is satisfactory with the restoration of a good aesthetic appearance of the ear and nose. Reconstruction of the external ear after partial traumatic amputation and post-traumatic nose defect with autocartilage from the ribs provides a stable aesthetic result and becomes the method of choice for such injuries.

WITHDRAWN: A comparison of ear amputations replantation techniques

The management of traumatic ear amputations remains a rare and difficult occurrence for surgeons. This is due to the fact that the chosen replantation technique must ensure the best vascular supply and the surrounding tissues have to be preserved as to not jeopardize a future auricular reconstruction in the event of replantation failure. This study aimed to review and synthesize the literature about the different surgical techniques described to date in the management of traumatic ear amputations (partial or total). Relevant articles were searched on PubMed, ScienceDirect, and Cochrane Library databases in accordance with the PRISMA statement guidelines. A total of 67 articles was retained. When possible, microsurgical replantation enabled the best cosmetic result but required important care. Pocket techniques and local flaps should not be performed because of the lower cosmetic result and the use of the surrounding tissues. However, they could be reserved for patients without access to advanced reconstructive techniques. When possible, microsurgical replantation can be attempted after patient consent for blood transfusions, postoperative care and hospital stay. Simple reattachment for earlobe amputations and ear amputations up to one third is recommended. When microsurgical replantation cannot be attempted, and if the amputated segment is viable and bigger than one third, simple reattachment may be attempted with an increased risk of replantation failure. In case of failure, an auricular reconstruction by an experienced microtia surgeon or prosthesis may be considered.

Microvascular Ear Replantation: A Multicenter Study of 22 Patients with Complete Ear Amputation.

Background: We aimed to report our experience in treating ear amputations with microvascular replantation, with the largest sample to date. Methods: Twenty-two patients with complete ear amputation underwent microvascular ear replantation at three medical centers between May 2003 and May 2020. Arterial anastomoses, venous anastomoses, or vein graft were performed depending on different situations. Re-exploration was performed in four patients due to venous congestion (n = 3) or arterial compromise (n = 1). Results: Eleven patients had vascular complications (venous congestion: 10, arterial compromise: 1) and four of them required re-exploration. Three ears were completely salvaged (75%) and one case failed. Eighteen (81.8%) replanted ears survived completely, with 15 repaired ears demonstrating a good contour and 3 ears showing atrophy. Three replanted ears sustained partial loss, and one sustained total loss. Three extraordinary cases with the longest ischemic time, smallest tissue size, and youngest age reported thus far all survived and had cosmetically satisfactory appearances. Statistical analysis indicated no significant correlation between replanted ear survival and potentially influential factors, including ischemic time, number of arterial and venous anastomoses, presence of vein graft, and re-exploration. Conclusions: Microvascular replantation for ear amputations achieved excellent results. It may be considered the primary choice for surgeons with microsurgical skill.

Primary Reattachment of Near-Complete Ear Amputation: A Successful Outcome.

Traumatic amputation of the ear constitutes a great aesthetic deformity that can have a tremendous negative impact. Reports describing the survival of near-complete ear amputation using non-microsurgical replantation are scarce. We aimed to study the surgical outcome of patients with near-complete ear amputations supplied by small pedicle bridges that were treated with primary reattachment. We retrospectively studied patients with near-complete ear amputation who were admitted at Al Ain Hospital from January 2016 to December 2019. Five patients were studied. The most common mechanism of injury was motor vehicle injury, followed by cutting injury. The skin pedicle was inferior in 3 (60%) patients of patients. The median width of the skin pedicles was 8.5 mm. The median interval between the injury and the surgical management was 4 hours. All patients underwent primary reattachment of the ear without microsurgery. One patient developed a small area of necrosis of the ear lobe. All patients recovered with a completely healed pinna and satisfactory overall appearance. Primary reattachment without microsurgery of the near-complete ear amputation can be safely performed in the presence of an intact skin pedicle. It can achieve an aesthetically satisfactory outcome without severe complications.

Hyperbaric Oxygen Therapy for Large Composite Grafts: An Alternative in Pediatric Facial Reconstruction

Management of pediatric facial defects can be challenging, as reattachment of large composite grafts is usually unsuccessful. Hyperbaric oxygen therapy (HBO) has been researched to augment composite graft survival, but clinical use for this application remains anecdotal. The authors present their successful experience managing select cases with large composite grafts and HBO as an adjunct. A retrospective chart review identified children presenting with facial defects and managed operatively with large composite grafts (≥1.5 × 1.5 cm) and HBO therapy. Records were reviewed for defect characteristics, management details, and outcomes at last follow-up. Nine children (avg. 8.4 years, range 1.6-15.1) presented with ear or nose defects secondary to dog bites (n=7), falls (n=1), or congenital causes (n=1). Three experienced ear amputations, and six suffered nasal avulsions of varying degrees. All avulsed ears were reattached. Three cases of nose avulsions were reattached; the other three underwent secondary reconstruction with composite ear grafts. HBO was initiated immediately and continued for 8-10 days. All grafts survived at least 80% with no postoperative complications. At last follow-up (avg. 30.1 months; 0.8-63.9), all patients demonstrated good cosmetic results with minimal residual deformity. When reconstruction of pediatric facial defects warrants a large chondrocutaneous graft, immediate postoperative HBO therapy can increase survival. Particularly when reattaching amputated segments, if successful, this approach offers an anatomically ideal result without donor site morbidity. If unsuccessful, it does not "burn bridges" and decreases the extent of secondary reconstruction.The authors present their HBO protocol along with a review of available literature.

Management of arteriovenous malformation of the ear: A protocol for resection and reconstruction.

Arteriovenous malformations (AVM) of the ear show unique features. Progressive growth or inadequate management of AVMs may lead to bleeding, infection, cartilage exposure, and ultimately loss of structure. Total ear amputation is an alternative; however, due to the structural complexity of the ear, reconstruction is technically challenging. This study presents a treatment algorithm based on a clinical series, with treatment options including resection and immediate and late reconstruction. Between 2004 and 2018, 12 patients with auricular AVMs were treated with AVM resection and ear reconstruction at our hospital. Among these 12 patients, seven were women, and patients' ages ranged between 4 and 34 years. Parameters considered before resection and reconstruction were compromised ear extension (partial, total, or extra-auricular involvement), thickness (cutaneous and cartilaginous), symptoms (bleeding, infection, ulceration, and/or cartilage exposure), and preoperative embolization. Total resection of AVMs was planned as the first step in all cases, followed by primary closure. AVM resection was categorized into a partial or total procedure, resulting in partial or total ear defects. Reconstruction was categorized as immediate or delayed. Preoperative embolization was performed in 10 patients. AVMs were totally removed, resulting in seven total ear amputations. In six of these patients, total ear reconstruction was performed 6 months later, and all patients were recurrence-free. Only one patient did not undergo ear reconstruction. Regrowth was not observed in any reconstructed ear. Treatment of ear AVMs requires a planned approach to achieve favorable clinical outcomes and for concomitant safe and definitive reconstruction. 4 Laryngoscope, 130:1322-1326, 2020.

Auricular reconstruction with polyethylene implants or silicone prosthesis: A single institution experience

Auricular reconstruction is usually necessary in patients with congenital malformations, after traumatic ear amputations or in cases of neoplastic ear disease.Thirty-nine patients who underwent an auricular reconstruction with either silicon prosthesis (21 patients) or porous polyethylene (18 patients) between 2002 and 2013 were retrospectively analyzed at a tertiary academic institution.A total of 25 male und 14 female patients were included in the study. In all, 43 implants were installed in 39 patients. An implant failure was not observed in any of the examined groups. An operative revision was necessary in 5 patients in the silicon prosthesis group (N = 21) and in 4 patients in the porous polyethylene group (N = 18). The most common side effect in the porous polyethylene group was the formation of retroauricular adhesions in 11.1 % by postoperative scaring, while in the silicone prosthesis group 71.4 % of the patients presented with skin reactions around the titanium implants.Our study shows that both techniques are valuable and should be offered to patients in cases of auricular reconstruction due to the low rate of severe complications and the good functional results of both techniques.

Car Accident Due to Horse Crossing the Motorway: Two Case Reports

Basic Commercial Court in Ankara wanted a report from our department of forensic medicine about two injury cases due to animal vehicle collision. The reports should include the disability rate and the duration of unfunctionality. After the examination we prepared the reports. Both vehicle collisions happened due to free ranging horse crossing the motorway. Both cases had different types of injury due to trauma. Vehicle collision due to horse crossing the motorway is rarely met in Turkey.
 Our first case is a man that had upper extremity and facial injury. He uses prothesis due to ear amputation. He has a scar tissue on the right side of his face and left forearm. The other case is three-years-old boy that had cranial bone fracture and cranial hematoma. He has also hemiparesis of the right side of body. Both cases have neurologic sequels but they have no psychiatric sequels. 
 In literature, animal vehicle collisions involve lots of animal species such as kangaroo, deer, camel and moose. Animal vehicle collision involving the horses is rarely met. Forensic medicine specialists should state the causal link between traumatic events and disabilities in order to help justice. Our aim to present the current two cases is investigation of injuries of animal related collision and makes forensic medicine specialists pay attention to the subject of preparing reports about such cases.
 Key words: Animal vehicle collision; death; disability; horse; injury; motorway.

Salvage of Unilateral Complete Ear Amputation with Continuous Local Hyperbaric Oxygen, Platelet-Rich Plasma and Polydeoxyribonucleotide without Micro-Revascularization

In many cases of complete ear amputation, microvascular surgery is required for tissue perfusion and organ survival. However, microvascular reconstruction is not always feasible in the absence of suitable vessels. Here, we present the case of a 76-year-old man who underwent complete amputation of the left ear after a collapse at home because of cardiogenic syncope. He was treated with primary replantation and underwent a postoperative salvage course including continuous local hyperbaric oxygen therapy (HBOT), platelet-rich plasma (PRP) injections, and polydeoxyribonucleotide (PDRN) injections. The ear was almost completely salvaged, with a tiny eschar at the mid-scapha on both the anterior and posterior aspects. This case demonstrates the efficacy of local HBOT with PRP and PDRN injections.

Reconstruction of Punitive Ear Amputations in Uganda: A Unique Surgical Burden of Disease.

Over the course of 12 months, a plastic surgical team from Paris, France, undertook 2 intensive ear reconstruction missions with plastic surgeons from the CoRSU Rehabilitation Hospital in Uganda. A cohort of over 30 adult women was assessed having been subjected to ear amputations by members of the Lords Resistance Army in Northern Uganda in the 1990s. The patients were identified, mobilized, and transferred to Kampala for surgery by a charitable arm of the Watoto Church, known as Living Hope. The surgical team performed 15 ear reconstruction cases during the first 1-week mission and 16 ear reconstruction cases during the second 1-week mission. All cases were reconstructed successfully using the 2-stage autologous auricular reconstruction method advocated by the senior author (FF). Local skin was used to cover the costal cartilage framework in the first stage without need for temporo-parietal fascial flaps. Technical challenges included the older age of patients and ossified costal cartilage, high prevalence of HIV positivity, bilateral amputation, and difficulty of surgical follow-up. The main modifications to standard practice were routine pre-op testing of the costal cartilage, pre-op viral load and CD4 count screening in HIV-positive patients, simultaneous bilateral first-stage ear reconstruction, prolonged hospital stay, and implementation of routine surgical counting procedures.

Microvascular salvage of a thrombosed total ear replant

Microvascular replantation, when possible, is the treatment of choice for total ear amputations. Both arterial and venous reconstruction should be attempted. The present case report describes a successful total ear replantation in a 45-year-old woman whose ear was amputated due to a horse accident. Venous thrombosis subsequently occurred and was managed with anticoagulation and leech therapy. Eighty hours after the replantation, arterial thrombosis took place. The posterior auricular artery thrombosed anastomosis was resected and reconstructed with an interposition vein graft. This report illustrates the feasibility of the successful microvascular salvage of a thrombosed total ear replant. It suggests the need for close clinical monitoring of the replanted ear and prompt microvascular reexploration in an event of the loss of arterial flow.

A novel technique for fabricating an ear prosthesis in a patient with congenital ear deformity

Microtia is one of the forms of ear loss and deformity. A prosthesis that is simple to apply, and which has adequate suspension and acceptable aesthetics, can be useful in the rehabilitation of patients with this deficit and can improve the social and psychological effects of patients with ear amputation. The aim of this article was to describe a novel technique for fabricating ear prosthesis in a patient with congenital ear deformity. This method involves a novel method to produce an ear prosthesis using clips that were located within the layers of the final silicone ear. This study demonstrated ease of use and acceptance by the patient. Design and fabrication of silicone ear prosthesis via this new method of suspension could also be suitable for provision to children with ear microtia who are not yet suitable for surgery or would not be suited to other methods of suspension. The new method of suspension demonstrated that this approach could be used to provide low cost and acceptable silicone ear prosthesis for patients with microtia and partial ear amputation.

Prosthetic rehabilitation of a patient with partial ear amputation using a self suspension technique

Partial ear amputations are one of the forms of ear loss. A user-friendly design of prosthesis with safe suspension and an aesthetic appearance can be helpful to a patient who has lost part of their ear due to congenital absence or trauma. Prosthetic use has social and psychological effects on the patient and their family. The aim of this paper is to describe a technique of ear prosthesis fabrication with self suspension for these patients. To provide a snugly fitting prosthesis, the only parts of the residual ear that were covered by the prosthesis were accurately manufactured and reduced in thickness to 0.5-1 mm and 10 mm in width, so that the silicone extended over the stumps to provide adequate suspension. This paper proposes the designing and constructing of a silicone ear prosthesis which had good suspension, low cost, was easy to use and was acceptable in appearance to the patient.

Revolving-door flap: An alternative for the coverage of acute burn defects of the auricle

Ears are special and unique structures that, if damaged, are key difficult to reconstruct. They are often underestimated during the acute treatment of burns. However, thermal injury of relatively moderate proportions can irreparably alter their shape and appearance. The usual management of auricular burns includes either conservative topical treatment, skin grafting with or without dermal substitutes and ear amputation during the acute phase or delayed reconstructive techniques for the treatment of secuelae. Herein we present our experience with a revolving-door (RD) flap used to cover a defect concerning the antihelical fold as a single stage procedure for the acute treatment of auricular-conchal burns.

Microsurgical Replantation and Salvage Procedures in Traumatic Ear Amputation

The purpose of this study is to present our experience with patients who underwent traumatic ear amputation. Between January 1988 and April 2002, 10 patients sustained ear amputations. Of these, six patients underwent microvascular replantation (arterial anastomosis only and arterial and venous anastomosis in three patients each), and replantation was attempted in one patient. However, no suitable vessel could be found for the anastomosis, and the amputated ear was treated as a composite graft and buried in a retroauricular pocket. Staged costal cartilage reconstruction was performed in three patients who lost the ear replant after trauma (two patients) or due to infection (one patient). The ear replant survived and showed good cosmetic results in the three patients who underwent arterial and venous anastomoses. The patients who had artery anastomosis only required intrareplant heparin injection (chemical leech) to resolve venous congestion and sustained partial loss of the replanted ear. Secondary procedures were necessary to repair the reconstructions, including an advancement, temporoparietal fascia, or retroauricular flap. Those who underwent staged ear reconstruction had late ear deformities. Microvascular replantation is the best method for reattaching an amputated ear, giving excellent esthetic results. If only arterial anastomosis is performed, a chemical leech is an option for decompressing the venous congestion. In those patients without a suitable vessel for microanastomosis, nonmicrosurgical methods are suggested, such as a temporoparietal fascia flap, retroauricular pocket procedure, or staged-costal cartilage reconstruction, depending on the ear defect.

Successful Replantation of an Amputated Earlobe by Microvascular Anastomosis

In the microsurgical area, replantation of ear amputation by microvascular anastomosis is considered to be the best method in terms of texture, color, and shape. Only a few cases of successful ear replantation with microvascular anastomosis have been reported because the size of the vessels is very small, and identifying appropriate vessels for anastomosis is difficult. Furthermore, most cases were total or subtotal (upper two thirds of the ear) amputations, and they were successfully reconstructed by replantation.To the best of our knowledge, this is the first case of a patient with ear lobe avulsion who underwent successful replantation by single arterial anastomosis. We report our case with a brief review of the literature.

Prise en charge des amputations traumatiques de l’oreille : revue de la littérature

Traumatic ear amputation (TEA) is a complete avulsion of a part or of the total auricular tissue. TEA are rare (only 74 cases have been described in the literature) and their handling is complex. The surgeon's objective is to obtain the best cosmetic result without demolishing the auricular area in order to allow future ear reconstruction in case of replantation failure. Many techniques of ear replantation have been described in the literature during the last 30 years: microsurgical replantation, pocket techniques and reattachment techniques. Microsurgical replantation should be achieved every time it is possible. When it is not possible, the surgeon can choose between ear reattachment and a pocket technique according to two clinical features: the size of the amputated part and the involvement of the ear lobe. Ear reattachment can be achieved when the amputated part is smaller than 15 mm or when amputation involves the earlobe. Pocket techniques, which are appropriate for the replantation of the auricular cartilage, can be used when the amputated part is bigger than 15 mm and does not comprise the earlobe.

Delayed, bilateral, non-microvascular ear replantation after violent amputation

Amputation of any body part is undoubtedly a traumatic experience leaving a terrible deformity, especially when the part or parts involved are visible and constitute an essential component of someone's facial whole. Bilateral ear amputation and successful subsequent replantation has been reported historically, but not in the modern surgical literature. We report the case of a 27-year-old female who was abducted and suffered a bilateral ear amputation at the hands of one of her captors to speed delivery of ransom money; the severed parts were sent to the parents approximately 2 hours after the amputation had taken place, and the girl was released some 48 hours after the ears were delivered. Microvascular replantation was attempted immediately after admission to the hospital some 2 hours after her release, but failed, and so a non-microvascular replantation was performed and was successful, after approximately 54 hours of ischaemia time. We consider this the first report of a complete bilateral, delayed, non-microvascular, successful ear replantation in a human being in the modern literature.