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Artery-Only Ear Replantation in a Child: A Case Report With Daily Photographic Documentation

Objective: Ear replantation poses a significant technical challenge even for the skilled microsurgeon. Many ear amputations result from avulsion and thus have damaged and often diminutive vessels with a paucity of veins. Artery-only replantation is an option for ear salvage, but little is published...

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Autores principales: Mendenhall, Shaun D., Sawyer, Justin D., Adkinson, Joshua M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Open Science Company, LLC 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5204358/
https://www.ncbi.nlm.nih.gov/pubmed/28101290
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author Mendenhall, Shaun D.
Sawyer, Justin D.
Adkinson, Joshua M.
author_facet Mendenhall, Shaun D.
Sawyer, Justin D.
Adkinson, Joshua M.
author_sort Mendenhall, Shaun D.
collection PubMed
description Objective: Ear replantation poses a significant technical challenge even for the skilled microsurgeon. Many ear amputations result from avulsion and thus have damaged and often diminutive vessels with a paucity of veins. Artery-only replantation is an option for ear salvage, but little is published on the clinical course and appearance after this procedure. Methods: A subtotal ear replantation was performed on a 10-year-old boy without a venous anastomosis. Leech therapy was used to manage venous congestion postoperatively, and daily photography was performed to document the clinical course. Results: Postoperative venous congestion was successfully managed with leech therapy. Four days after the replantation, arterial thrombosis occurred that required a take back and salvage with an interposition vein graft for arterial repair. Native venous drainage and arterial revascularization from skin edges were evident by postoperative day 12, and leeches were discontinued on day 14. The patient required debridement of the posterior ear and superior helix necrotic skin, with burying of the upper portion of the ear in a superior auricular skin flap. The ear was subsequently released from the head, and the exposed portions were covered successfully with a full-thickness skin graft. Conclusions: While arterial and venous anastomoses should always be attempted, arterial-only ear replantation can provide excellent results when venous congestion is properly managed. Daily photography can be a useful tool to monitor subtle skin color changes that may indicate native venous drainage and arterial revascularization.
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spelling pubmed-52043582017-01-18 Artery-Only Ear Replantation in a Child: A Case Report With Daily Photographic Documentation Mendenhall, Shaun D. Sawyer, Justin D. Adkinson, Joshua M. Eplasty Journal Article Objective: Ear replantation poses a significant technical challenge even for the skilled microsurgeon. Many ear amputations result from avulsion and thus have damaged and often diminutive vessels with a paucity of veins. Artery-only replantation is an option for ear salvage, but little is published on the clinical course and appearance after this procedure. Methods: A subtotal ear replantation was performed on a 10-year-old boy without a venous anastomosis. Leech therapy was used to manage venous congestion postoperatively, and daily photography was performed to document the clinical course. Results: Postoperative venous congestion was successfully managed with leech therapy. Four days after the replantation, arterial thrombosis occurred that required a take back and salvage with an interposition vein graft for arterial repair. Native venous drainage and arterial revascularization from skin edges were evident by postoperative day 12, and leeches were discontinued on day 14. The patient required debridement of the posterior ear and superior helix necrotic skin, with burying of the upper portion of the ear in a superior auricular skin flap. The ear was subsequently released from the head, and the exposed portions were covered successfully with a full-thickness skin graft. Conclusions: While arterial and venous anastomoses should always be attempted, arterial-only ear replantation can provide excellent results when venous congestion is properly managed. Daily photography can be a useful tool to monitor subtle skin color changes that may indicate native venous drainage and arterial revascularization. Open Science Company, LLC 2016-12-28 /pmc/articles/PMC5204358/ /pubmed/28101290 Text en Copyright © 2016 The Author(s) http://creativecommons.org/licenses/by/2.0/ This is an open-access article whereby the authors retain copyright of the work. The article is distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Journal Article
Mendenhall, Shaun D.
Sawyer, Justin D.
Adkinson, Joshua M.
Artery-Only Ear Replantation in a Child: A Case Report With Daily Photographic Documentation
title Artery-Only Ear Replantation in a Child: A Case Report With Daily Photographic Documentation
title_full Artery-Only Ear Replantation in a Child: A Case Report With Daily Photographic Documentation
title_fullStr Artery-Only Ear Replantation in a Child: A Case Report With Daily Photographic Documentation
title_full_unstemmed Artery-Only Ear Replantation in a Child: A Case Report With Daily Photographic Documentation
title_short Artery-Only Ear Replantation in a Child: A Case Report With Daily Photographic Documentation
title_sort artery-only ear replantation in a child: a case report with daily photographic documentation
topic Journal Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5204358/
https://www.ncbi.nlm.nih.gov/pubmed/28101290
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