Atypical replantation and reconstruction of frozen ear: A case report

• Published in: Medicine (Baltimore) Vol. 99; no. 20; p. e20068
• Main Authors: Dvořák, Zdeněk, Stupka, Igor
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health 15.05.2020
• Subjects: Adult; Amputation, Traumatic - surgery; Clinical Case Report; Cryopreservation; Ear, External - injuries; Ear, External - surgery; Humans; Male; Occupational Injuries - surgery; Reconstructive Surgical Procedures - methods; Replantation - methods
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000020068

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. We report the case of a 38-year-old man, who had an injury to the head while working with a machine. 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. We attempted replantation. Despite repeated arterial thrombosis during surgery, the ear was successfully replanted with arterial and venous anastomosis. 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. 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.