Auricular avulsion injuries and reattachment techniques: A systematic review. Issue 3 (14th April 2020)

• Record Type: Journal Article
• Authors: Gailey, Andrew D.; Farquhar, Douglas; Clark, Joseph Madison; Shockley, William W.
• Is Part Of: Laryngoscope investigative otolaryngology. Volume 5:Issue 3(2020)
• Page Start: 381
• Page End: 389
• Publication Date: 2020-04-14
• Subjects: auricular avulsion -- auricular avulsion injury -- Baudet method -- ear avulsion -- microsurgical repair -- microvascular repair -- periauricular skin -- platysma myocutaneous flap -- pocket principle -- temporoparietal fascia flap; Otolaryngology -- Periodicals; Laryngoscopy -- Periodicals; Otolaryngology; Otolaryngology; Periodicals; Periodicals; 617.51
• DOI: 10.1002/lio2.372
• Languages: English
• ISSNs: 2378-8038

Abstract

Abstract: Objective(s): Multiple surgical techniques exist in the acute management of auricular avulsion injuries, including reattachment of the tissue as a composite graft, reconstruction using local skin flaps, the pocket principle, the Baudet method, and microvascular repair. This review aimed to compare the success rates of reattachment methods in auricular avulsion injuries. Methods: A PubMed search systematically identified cases in which (a) an auricular avulsion injury occurred and (b) reattachment was attempted. Search results were combined with an extensive review of references from published studies. In total, 148 cases were identified. Three reviewers independently graded the final aesthetic result of each case using a 5‐ point scale. The average grade of each repair was compared to the reattachment method to identify successful techniques. Results: Microvascular repair was associated with a statistically significant higher success rate compared to all other reattachment methods. Composite graft reattachment also tended to generate better final aesthetic outcomes, but this difference was not statistically significant. Conclusion: Microvascular repair of the avulsed segment consistently demonstrated higher success rates. Composite graft reattachment should also be considered under the right circumstances. Overall, microvascular repair and composite graft reattachment should be considered the best options in cases of auricular avulsion repair. The authors share a major concern that other methods that rely on the use of periauricular skin will compromise any future attempts for secondary reconstruction, such as staged procedures using costal cartilage grafts. Manipulation of these tissues and in particular burying of the avulsed ear cartilage is discouraged. Level of Evidence: 4