Using an unconventional perfusion pattern in ear replantation-arterialization of the venous system

Momeni A, Parrett BM, Kuri M (2014) · Microsurgery · n=1

RCT evidence detailTrial reference

GRADE Very LowInsufficient evidenceCondition: Microsurgical Replantation (Digit / Ear / Scalp) →

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 (25-year-old male, human bite injury, Stanford University Medical Center)
Sample size (n): 1
Intervention: Subtotal ear replantation with end-to-end arterio-venous anastomosis (arterialization of venous system) without vein grafts; postoperative leech therapy for venous drainage
Comparator: Conventional arterial-venous anastomotic patterns
Primary endpoint: Ear survival with non-conventional perfusion pattern
Primary result: Successful ear survival with arterialization of venous system; postoperative leech therapy provided venous drainage; discharged after 14 days; reportedly first case of subtotal ear amputation successfully replanted by arterialization of venous system
Follow-up duration: Postoperative discharge at 14 days
PMID: 25116223

Key Findings

First reported successful ear replant via venous system arterialization
End-to-end arterio-venous anastomosis without vein grafts
Postoperative leech therapy enabled unconventional perfusion
14-day hospitalization to discharge
Preserves superficial temporal vessels for future use

Limitations

Single case - hypothesis-generating only
Cannot generalize unconventional approach
Limited long-term aesthetic data
Patient selection criteria for venous arterialization unclear
Human bite mechanism may limit comparison to other amputations

Clinical Implications

Momeni 2014 demonstrates how reliable leech-mediated venous drainage support enables surgical innovation - specifically, unconventional venous system arterialization in ear replantation. For US clinicians under K040187, this case illustrates the device's enabling role for technical innovation in challenging anatomic scenarios where conventional vein grafting is not feasible.

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