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Leeching as Salvage Venous Drainage in Ear Reconstruction

Clinical Case and Review of Literature

Facchin, Federico, MD*,‡; Lancerotto, Luca, MD, PhD; Arnež, Zoran Marij, MD, PhD*; Bassetto, Franco, MD; Vindigni, Vincenzo, MD, PhD

Plastic and Reconstructive Surgery – Global Open: November 5, 2018 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000001820
Latest Articles: PDF Only

Background: Ear avulsion is a rare complication of different traumas, such as car accidents, human or animal bites and stab wounds, and can result in dramatic cosmetic consequences for the patient. Ear replantation, revascularization, and reattachment are the options offering best aesthetic results. But venous outflow insufficiency is responsible for a high rate of failures. Leeching is one the most efficient methods to relieve venous congestion. It has been used as an alternative venous outflow in case of severe impairment of the physiologic one.

Methods: We present a case of successful rescue of a congested reattached ear by leeching after subtotal avulsion, along with a review of the literature on cases of avulsed auricle reconstruction salvaged by hirudotherapy. Data were collected and analyzed to identify a best regimen to deal with venous congestion.

Results: More than 130 cases of avulsed auricle savage are described in the literature, in a fourth of which leech therapy was used in the management of venous congestion.

Discussion: In case of both venous outflow deficit or absence, leeches are a potentially successful option to correct the congestion while new veins reestablish normal physiology. The need for anticoagulant/antiaggregant therapy, antibiotics, and often blood transfusion are the main pitfalls of leeching.

Conclusion: Leeches can be considered a salvage method for ear replantation and reattachment in those cases that lack venous outflow in the presence of valid arterial inflow.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the *Department of Plastic and Reconstructive Surgery, University of Trieste, Trieste, Italy

Department of Plastic Surgery, St. John’s Hospital, NHS Lothian, Scotland, United Kingdom

Clinic of Plastic and Reconstructive Surgery, University of Padova, Padua, Italy.

Published online 5 November 2018.

Received for publication December 19, 2016; accepted April 16, 2018.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

F Facchin, Department of Plastic and Reconstructive Surgery, University of Trieste, Trieste, Italy Clinic of Plastic and Reconstructive Surgery University of Padova Padua, Italy, E-mail: federicofacchin@yahoo.it

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.