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Updated: Sep 12, 2026
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Survival Outcomes in Microvascular Ear Replantation With and Without Venous Repair: An Updated Systematic Review and
Muaz Zuhurlu1, Mahmut Tekecik2, Bilsev İnce2
1Department of Plastic, Reconstructive and Aesthetic Surgery, Sakarya Training and Research Hospital, Sakarya, Türkiye.
Purpose:
Microvascular ear replantation remains technically demanding, and the necessity of venous repair continues to be debated. Previous systematic reviews have not demonstrated a clear survival advantage associated with venous anastomosis. This study aimed to provide an updated, PRISMA-guided systematic review evaluating outcomes of auricular replantation with and without venous repair and to identify factors associated with replantation success.
Materials And Methods:
A systematic search of PubMed/MEDLINE, ScienceDirect, and Google Scholar was conducted from database inception to September 2025. Human cases of complete or partial auricular replantation using microvascular techniques with documented operative details and outcomes were included. Patient-level data regarding demographics, injury characteristics, vascular repair, venous outflow management, postoperative treatment, and outcomes were extracted. Available case analyses were performed using the Fisher exact test, the Mann-Whitney U test, and appropriate multicategory comparisons. Exploratory logistic regression was used to assess factors associated with failure.
Results:
Forty-seven studies comprising 92 microvascular ear replantations were included. Sixty-four cases underwent arterial and venous repair (A+V), 25 artery-only repair (A-only), and 3 arteriovenous anastomosis. Success was achieved in 58/64 A+V cases (90.6%), 17/25 A-only cases (68.0%), and all 3 arteriovenous cases. Failure was significantly more frequent after A-only than A+V reconstruction (32.0% vs. 9.4%; OR, 4.55; 95% CI, 1.39-14.93; P=0.019). Venous congestion (92.0% vs. 50.8%; P<0.001) and blood transfusion requirement (82.4% vs. 48.1%; P=0.030) were also more frequent in the A-only group. In exploratory multivariable analysis, A-only reconstruction remained associated with increased odds of failure (adjusted OR, 6.16; 95% CI, 1.65-23.02; P=0.007).
Conclusion:
Venous repair was associated with significantly higher success rates in microvascular ear replantation and lower rates of postoperative venous congestion. Whenever technically feasible, at least one venous anastomosis should be pursued. When venous repair is not possible, structured external blood drainage strategies and close monitoring of transfusion requirements remain important components of postoperative management.
