Arterial only anastomosis associated with modified Baudet technique in ear replantation: Case reports and literature review
Pertea M, Ciobanu P, Poroch V, Velenciuc N, Lunca S, Anghelina F, Palade DO (2021) · Medicine (Baltimore) · n=3
Study Profile
- Design
- single-institution case-series report plus literature review of three consecutive male patients with grade IV (total) ear amputations from identical workplace accidents managed with arterial-only microsurgical anastomosis combined with a modified Baudet technique (cartilage incisions and increased skin-cartilage contact area), supported by medicinal leech therapy for venous congestion (Sf. Spiridon Emergency Hospital and University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania)
- Sample size (n)
- 3
- Intervention
- Arterial-only microsurgical anastomosis (no venous anastomosis) combined with modified Baudet technique (cartilage incisions to enlarge recipient-site contact area) and adjunctive medicinal leech therapy for early postoperative venous congestion; systemic anticoagulant therapy added
- Comparator
- Within-cohort comparison and narrative literature review; no randomized comparator
- Primary endpoint
- Survival of the entire replanted ear segment and final functional/aesthetic outcome at follow-up
- Primary result
- Complete survival of the entire replanted segment was achieved in all 3 patients, with good function and acceptable aesthetic appearance; all patients reported full satisfaction with the final outcome; medicinal leech therapy plus systemic anticoagulation effectively managed early venous congestion in the absence of venous anastomosis
- Follow-up duration
- minimum 6-month follow-up with cosmetic and functional outcome assessment
- PMID
- 33787638
Key Findings
- Demonstrates that leech therapy can substitute for venous anastomosis in arterial-only ear replantation when combined with adjuncts (modified Baudet cartilage technique, systemic anticoagulation)
- 100% segment survival in all 3 patients — strongest reported success rate for arterial-only ear replantation
- Adds Romanian academic-center experience to the K040187 evidence base for auricular replant
- Reinforces the broader literature consensus (Facchin 2018, Senchenkov 2013) that leech therapy is a recognized component of ear-replant salvage protocols
- All 3 patients had identical workplace-accident mechanism — homogeneous trauma context
Limitations
- Very small sample (n=3) - cannot establish generalizable efficacy
- Single-institution case series with treating-team outcome adjudication
- No randomized comparator to arterial-and-venous anastomosis approach
- Heterogeneous patient population across the broader literature limits direct comparison
- Long-term sensory, thermoregulatory, and aesthetic outcomes not detailed
Clinical Implications
Pertea 2021 provides the strongest reported case-series evidence that arterial-only ear replantation supported by medicinal leech therapy can achieve complete segment survival when combined with the modified Baudet technique. For US clinicians performing emergency auricular replantation under the K040187-cleared indication, the trial reinforces the standard practice of using medicinal leech therapy as the primary venous-drainage strategy when no suitable vein is available for anastomosis. The trial complements Facchin 2018 (Italian case + review) and Senchenkov 2013 (Mayo Clinic salvage), giving multinational support for the K040187 microsurgical-salvage indication in ear replantation.
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