Ear Reconstruction /Ear Amputation per Dog Bite Avulsion

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PREOP DIAGNOSIS: Right ear amputation.

POSTOP DIAGNOSIS: Right ear amputation.

OPERATIONS PERFORMED: Microscopic replantation of right ear with microvascular anastomosis. Insetting and closure of cartilage, subcutaneous tissue and skin.

PROCEDURE: The patient was placed in the supine position where he was sterilely prepped and draped. About 40% of the ear was avulsed and was brought in on saline and ice.

This was taken to a side table with the microscope and vessels and nerves were identified. Debridement of avascular, irregular cartilage was done and skin as well. The part was cleaned and small vessels were identified. An artery was identified in the area of avulsion of the ear anteriorly. After inspecting the
part, microscope was brought into the area of avulsion and a reasonable flow to a small vessel was identified. Veins were more difficult to see. Multiple cutaneous nerves were present. Using the microscope and 10-0 nylon, a standard end-to-end microvascular repair was performed on the 0.3-mm vessels. This required 2 revisions and, after this, persistent flow was obtained. Clamps were released and small veins were identified. The veins within the area of
avulsion were more difficult. Two regions were identified, but several revisions performed. Vessels were extremely small and thin and 10-0 was rather large suture. There was some flow through one of the veins and this was left intact. A single vein was utilized and then degrees-epithelialization was done posteriorly to try to assist in venous collateralization.

Skin was repaired with 5-0 Prolene as was the cartilage. Polysporin ointment was applied. Xeroform was applied and retaining sutures were released.
Excellent flow remained in the flap, though certainly future concern for venous congestion was present. The rest of the skin was closed with 5-0 chromic catgut. Dry sterile dressings were applied. The patient tolerated the procedure well and was transferred to Recovery Room in satisfactory condition.