American Society of Hirudotherapy

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

Mendenhall SD, Sawyer JD, Adkinson JM (2016) · Eplasty · n=1

RCT evidence detailTrial reference
GRADE Very LowInsufficient evidenceCondition: Microsurgical Replantation (Digit / Ear / Scalp) →
Sample size of this trial compared with other Microsurgical Replantation (Digit / Ear / Scalp) trialsArbel EJ 202446Battin AO 202312Hong Ha N 20254van Alphen NA 20142Mendenhall SD 20161Akhoondinasab MR 20231Banihani OI 20141Mousa A 20221Momeni A 20141Senchenkov A 20131
This trial (highlighted) by sample size alongside other indexed Microsurgical Replantation (Digit / Ear / Scalp) trials. Larger trials generally carry more statistical weight.

Study Profile

Design
single-patient case report with daily photographic documentation (10-year-old boy, Southern Illinois University School of Medicine)
Sample size (n)
1
Intervention
Subtotal ear replantation without venous anastomosis with leech therapy for venous congestion management; daily photography
Comparator
No control - single case with photographic protocol
Primary endpoint
Ear survival, native venous drainage development, and arterial revascularization
Primary result
Successful venous congestion management with leech therapy through postoperative day 14; arterial thrombosis at day 4 required take-back and interposition vein graft salvage; partial necrosis required debridement and skin graft
Follow-up duration
Postoperative recovery + skin graft healing
PMID
28101290

Key Findings

  • Artery-only ear replantation with 14-day leech therapy
  • Daily photography as monitoring tool
  • Native venous drainage confirmed by skin color change
  • Arterial thrombosis at day 4 required take-back
  • Long-term aesthetic salvage achieved with multi-stage repair

Limitations

  • Single pediatric case - limited generalizability
  • Late arterial thrombosis complicates outcome attribution
  • Aesthetic outcome judgment subjective
  • Skin graft on posterior ear suboptimal aesthetic
  • Cannot generalize from school-aged child

Clinical Implications

Mendenhall 2016 establishes a methodological standard for artery-only ear replantation: daily photography as monitoring tool, ~14 days of leech therapy when no venous anastomosis, and readiness to revise if arterial thrombosis develops. For US clinicians under K040187, the photographic documentation protocol enables objective assessment of native venous drainage development and informs leech discontinuation timing.

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This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.