American Society of Hirudotherapy

Microsurgical ear replantation - is venous repair necessary? A systematic review

Systematic review published in Microsurgery (2015)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Systematic reviewClinical LiteratureMomeni A et al. · Microsurgery, 2016

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.

Publication typeJournal ArticleSystematic Review
Indexed MeSH termsAmputation, TraumaticArteriesEar, ExternalHumansMicrosurgeryReplantationTreatment OutcomeVeins

Summary

A systematic review of 60 microsurgical ear replantation cases found 63.3% had arterial plus venous anastomosis versus 31.7% artery-only, with operative time the only significantly different outcome, 2.6 hours longer in the dual group.

Context

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. 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. Leeches are not specifically mentioned; the review focuses on surgical technique rather than leeching outcomes.

Citation

Reference (Vancouver style)

Momeni A, Liu X, Januszyk M, Wan DC, Buncke GM, Buntic RF, et al. Microsurgical ear replantation - is venous repair necessary? A systematic review. Microsurgery. 2016;36(4):345-350. doi:10.1002/micr.22411. PMID: 25847853

Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.

DOIPubMed

Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026

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.