A multifaceted approach for traumatic auricular avulsion with venous congestion
Case report published in Harefuah (2020)
Abstract
Choice of operative technique is often a major factor in the success of replantation of traumatic avulsions of the auricle. While microsurgery is considered to produce the best aesthetic results, this approach may not be an option due to vascular damage. We present the case of a 66-year-old Caucasian male with a subtotal traumatic left auricle avulsion. Microsurgical repair was not attempted as vessels amenable to anastomosis could not be found. Instead, the auricle was replanted in a non-microsurgical manner as a composite graft using Monocryl sutures. As a preventative measure for clot formation heparin was injected intradermally throughout the anterior auricular surface and helix. Twenty-four hours postoperatively, as signs of venous congestion were noted, a multimodal therapy was initiated combining mechanical, chemical and biological therapies. Medicinal leech therapy (hirudotherapy) was used to enhance venous drainage and prevent clot formation. Hirudotherapy is an effective and safe treatment modality for venous outflow obstruction in avulsed auricle injuries. However, one must consider the possible complications of leech therapy and the need for close monitoring. An examination conducted two months following the initial injury revealed optimal patient outcomes with excellent aesthetic results and full auricular sensation. Good vascular outflow is integral to the successful salvage of replanted tissues. Venous stasis must be identified and addressed early for good patient outcomes. The current report highlights the importance of a multifaceted approach in cases of traumatic auricular avulsions followed by venous congestion.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Hebrew-language case detailing combined operative and adjunctive management of severe venous congestion after auricular avulsion repair, including hyperbaric oxygen, anticoagulation, and medicinal leech therapy.
Why This Matters for Hirudotherapy
This case report describes a 66-year-old man with subtotal traumatic auricular avulsion managed by non-microsurgical replantation as a composite graft, as no vessels amenable to anastomosis could be found. Intradermal heparin was injected to prevent clot formation; when venous congestion appeared 24 hours postoperatively, multimodal therapy was initiated including medicinal leech therapy (hirudotherapy) to enhance venous drainage and prevent clotting. At two-month follow-up, excellent aesthetic results and full auricular sensation were achieved. For ASH's domain, this provides direct clinical evidence supporting hirudotherapy as an effective and safe modality for venous outflow obstruction in avulsed auricular tissue. Caveat: This is a single case report without a control group; the abstract notes that possible complications of leech therapy and the need for close monitoring must be considered.
Citation
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