Anterior approach to posterior auricular artery in microvascular anastomosis - a new concept in replanting amputated ears - experience from four successful cases and literature review
Hong Ha N, Thanh Huyen TT (2025) · Acta Chirurgiae Plasticae · n=4
RCT evidence detailTrial reference
Study Profile
- Design
- single-institution case series of 4 successful microsurgical auricular replantations using novel anterior approach (February 2012-July 2022)
- Sample size (n)
- 4
- Intervention
- Microsurgical ear replantation via supine position and anterior observation of posterior auricular artery (0.4-0.5 mm diameter); leech therapy 10-14 days postoperatively in 2 cases where venous anastomosis could not be achieved
- Comparator
- Historical posterior approach and venous-anastomosis cases
- Primary endpoint
- Ear survival and aesthetic outcomes after microvascular replantation
- Primary result
- All 4 cases (100%) successful with anterior approach; 2/4 patients required 10-14 days of leech therapy for venous drainage when vein anastomosis impossible; ischemia duration 4-14 hours; blood transfusion 3-4 units
- Follow-up duration
- Postoperative + long-term aesthetic assessment
- PMID
- 41996214
Key Findings
- Novel anterior approach for posterior auricular artery exposure
- 100% success rate in 4 cases (2012-2022)
- Extended leech protocol 10-14 days for artery-only cases
- Traffic accidents (3/4) and violence (1/4) as causes
- Posterior auricular artery diameter 0.4-0.5 mm achievable
Limitations
- Small case series (n=4) over 10 years
- Single institution experience
- Novel approach without comparative cohort
- Limited long-term aesthetic outcome data
- Acta Chirurgiae Plasticae has limited international visibility
Clinical Implications
Hong Ha 2025 contributes a novel anterior surgical approach plus protocol for extended (10-14 day) leech therapy in artery-only auricular replantation. For US clinicians under K040187, this provides duration evidence beyond typical 5-7 day protocols and validates leech adjunct in artery-only scenarios when venous anastomosis is technically impossible.
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