Totally avulsed ear: new technique of immediate ear reconstruction.

Introduction: Reconstruction of the avulsed auricle remains a challenge to the plastic surgeon. Many surgeons suggest reattachment of the total or subtotal amputated ear as a composite graft, but this solution is unreliable. Some surgeons advocate the use of the retro auricular pocket to enhance survival of the reattached ear. However, this burying method entails multistage procedures with somewhat poor results due to the associated fibrosis. Microsurgical replantation can be performed but its applicability is limited due to difficulty with venous drainage. In this paper we advocate the use of a technique of total ear reconstruction using the cartilage of the avulsed ear in a single stage.

Patients: Three patients with a mean age of 36 years, all of whom were heavy smokers, were operated upon between February 2006 and January 2007. Surgery involved removal of the skin of the amputated ear and immediate reattachment. The ear cartilage was then, immediately covered with an ipsilateral temporoparietal fascia flap and a split thickness skin graft.

Results: Acceptable aesthetic results were obtained in all three cases. A minor complication of limited skin graft loss occurred in one case.

Conclusion: Our technique is simple, one stage and maintains the delicate detail of the auricular cartilage.