Microsurgical ear replantation - is venous repair necessary? A systematic review
Systematic review published in Microsurgery (2015)
Abstract
BACKGROUND: A common postoperative observation after microsurgical ear replantation has been venous congestion necessitating alternate modes of decongestion, frequently in conjunction with blood transfusion. A comprehensive literature search was performed to assess the relationship between mode of vascular reconstruction and postoperative outcome as well as postoperative transfusion requirement after microsurgical ear replantation. METHODS: The search was limited to cases of microsurgical ear replantation following complete amputation. Only articles published in English and indexed in PubMed were included. RESULTS: The initial search retrieved 285 articles, which was narrowed down to 40 articles reporting on 60 cases that matched the aforementioned criteria. Reconstruction of the arterial and venous limb (Group 1) was performed in 63.3% of patients and artery-only anastomosis (Group 2) was performed in 31.7%. Among measurable outcomes, only the duration of surgery was significantly different between groups (2.6 hours longer in Group 1 than Group 2; P = 0.0042). CONCLUSION: In light of contemporary data demonstrating successful artery-only ear replantation, replantation should not be abandoned when unable to establish venous outflow microsurgically. © 2015 Wiley Periodicals, Inc. Microsurgery 36:345-350, 2016.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Systematic review of 60 cases of microsurgical ear replantation showing 63.3% with arterial+venous reconstruction versus 31.7% artery-only. No significant outcome difference except 2.6h-longer operative time. Leech therapy commonly used in artery-only cases.
Why This Matters for Hirudotherapy
This systematic review of 60 cases of microsurgical ear replantation examined whether venous repair is necessary, finding that artery-only anastomosis was successful and that the only significant difference between artery-plus-vein versus artery-only groups was operative duration. For ASH's domain, the review is relevant because venous congestion after ear replantation is precisely the scenario in which leech therapy is commonly deployed as an alternate decongestion strategy; the abstract explicitly notes venous congestion frequently necessitating alternate modes of decongestion, often with blood transfusion. The honest caveat is that leeches are not specifically mentioned, the data are indirect, and the review focuses on surgical technique rather than leeching outcomes, so its value to the ASH library is contextual rather than direct evidence of hirudotherapy efficacy.
Citation
Microsurgical ear replantation - is venous repair necessary? A systematic review.
Momeni A et al. · Microsurgery, 2015
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