Ear REPLANTATION

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A 19-year-old woman presented with amputation of her left ear by a pit bull (Panels A and B). The patient’s tetanus vaccination and the dog’s rabies vaccination were up to date. The ear was débrided and replanted by microvascular anastomosis of a 0.3-mm branch of the posterior auricular artery. Since no suitable veins were found, medicinal leeches (Hirudo medicinalis) provided venous drainage for 17 days (Panel C). Ciprofloxacin was administered as prophylaxis against Aeromonas hydrophila bacteria, which are found in a leech’s digestive tract. Aspirin and heparin, followed by enoxaparin, were administered to prevent thrombosis. The patient recovered without complications. The ear did not lose viability, and 24 days postoperatively, a normal appearance had been restored (Panel D); 4 months postoperatively, the result was stable and the normal appearance was maintained. Although advances have been made in bioengineering and allogeneic transplantation of facial structures, replantation of a patient’s own tissue is ideal when possible.

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