Delayed ear reconstruction: case report of reconstruction of an avulsed ear 2 days after injury

Auricular reattachment and reconstruction following traumatic ear avulsion is a challenging surgical problem. Suggested reconstruction methods include direct reattachment, composite grafting, pocket methods, coverage with periauricular flaps, and microsurgical repair. A published alternative is reattachment and burial of the amputated part under a postauricular flap. If circumstances delay the surgical intervention, what is a safe window to still consider this form of treatment? In the current report, we present a case of a complete partial ear avulsion, which was reattached in the ER as a free graft. Two days later the cartilage was banked under a postauricular flap. A 22 year-old male had his ear was completely bitten off which was re-attached. Two days later the skin of the avulsed segment was dark and bloodless. The avulsed segment was removed from the ear. The overlying skin was dissected off of the attached ear leaving perichondrium on the medial aspect of the ear. The cartilage was then reattached. A postauricular pocket/flap was created and the ear tucked and secured to the postauricular fascia and skin closed overtop. Five weeks later, the patient had division and inset of the flap with a full thickness skin graft to the posterior aspect of the ear. Our results and experiences suggest that immediate reconstruction may not be crucial.