Two cases of microscopic replantation of auricular dissection in different planes: Case report

RATIONALE: Auricular lacerations are commonly encountered in clinical practice, and such injuries can cause significant damage to both the appearance of the face and the emotional well-being of the individual. This case report presents the clinical experience and key considerations of microreplantation of auricular lacerations in different planes, aiming to provide a reference for clinical treatment. PATIENT CONCERNS: This study analyzed 6 cases of auricular avulsion microsurgical replantation, all achieving excellent clinical outcomes. After systematically evaluating various anatomical planes, long-term follow-up (up to 6 years), and different surgical techniques (anterograde vs retrograde replantation), we present 2 representative cases. All patients underwent meticulous preoperative assessment of the avulsed auricles followed by successful microsurgical replantation. Postoperative results demonstrated well-survived replanted auricles without significant pigmentation changes, near-complete sensory recovery, and fully preserved auditory function. DIAGNOSES: Due to various unpredictable causes such as trauma, the auricle can undergo avulsion at different planes, which is diagnosed through physical examination. The examination revealed exposed and fractured auricular cartilage at both the proximal and distal ends, with active bleeding points at the proximal ear and partial contusions at the distal auricle. INTERVENTIONS: According to the avulsion plane of the auricle, followed by meticulous debridement of both the proximal and distal segments under microscopy, employing a carpet-like excisional technique. Depending on the vascular anatomy and extent of tissue loss, either anterograde or retrograde microvascular replantation was performed. Long-term follow-up was conducted to evaluate outcomes. OUTCOMES: Both replanted auricles survived completely. Postoperative follow-up ranged from 6 months to 7 years. One patient developed a venous crisis leading to scab detachment and mild auricular collapse. Another case exhibited partial skin loss at the junction of the auricle and earlobe. At 10 weeks postoperatively, the second patient underwent a Z-plasty revision under local infiltration anesthesia to address the defect. At final follow-up, all replanted auricles showed no significant pigmentation, near-normal sensory recovery, and preserved auditory function. LESSONS: Intraoperative exploration of vascular integrity based on the level of injury is essential, allowing for precise microvascular anastomosis under microscopy. Adequate vascular anastomosis significantly promotes the survival of the replanted auricle.

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Two representative cases from a six-case series of auricular avulsion replantation demonstrate that meticulous vascular exploration and anterograde or retrograde microvascular anastomosis achieved complete survival, near-normal sensation, and preserved hearing at up to seven years.

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