Background: Ear replantation is a time-sensitive and technically complex procedure which provides the most optimal aesthetic and functional reconstruction. Unfortunately, most ear amputations result from avulsion injuries, which can attenuate and cause severe damage to small vessels, hindering successful replantation.
Methods: A single-artery replantation, without venous anastomosis, was performed on a 26-year-old male with complete auricle avulsion caused by a human bite. The entire avulsed ear, aside from a small intact portion of lobe, was reattached using microvascular repair techniques. Postoperative venous congestion was managed with leech therapy.
Results: Single-artery replantation was successful, yielding an excellent aesthetic outcome despite a near-total ear amputation. Significant postoperative venous congestion was effectively circumvented with hirudotherapy. The only complication was a small <1cm posterior pinna dehiscence which required repair under local anaesthetic on day twelve.
Discussion: The absence of salvageable veins is not an absolute contraindication for ear revascularization. Single-artery replantation has proven to be a viable option for patients with ear avulsion. Leech therapy is crucial for relieving venous congestion and can temporarily compensate for the total absence of venous outflow until new veins reestablish circulation. Nonetheless, careful selection of candidates for auricular replantation remains essential.
Conclusion: While robust arterial inflow and venous outflow are ideal in ear replantation, both this case and contemporary evidence demonstrate that artery-only replantation can yield excellent results when venous congestion is managed proactively with hirudotherapy.