A patient presents within two hours of complete clean auricular avulsion; the amputated pinna has been kept cool and moist. Microsurgical expertise is available. What offers the best reconstructive prospect?
When vessels and tissue are suitable, microsurgical replantation best preserves the native three-dimensional cartilage framework; venous congestion must be anticipated and actively managed.
A. Direct composite reattachment of the whole pinna without microvascular assessment: Composite reattachment may suit smaller segments or absent microsurgical capability, but survival of a complete adult auricle is less reliable.
B. Use the postauricular pocket technique as first choice: Pocket techniques can flatten or resorb cartilage and consume tissue needed for later reconstruction.
C. Urgent microsurgical replantation after debridement and vessel assessment: When vessels and tissue are suitable, microsurgical replantation best preserves the native three-dimensional cartilage framework; venous congestion must be anticipated and actively managed.
D. Debride the amputated pinna and perform immediate costal-cartilage reconstruction: Discarding viable native framework is premature when timely replantation is feasible.
E. Perform arterial anastomosis but make no plan for venous congestion: Artery-only replantation may be necessary, but active venous drainage, monitoring and possible transfusion must be anticipated.
If the segment were crushed, contaminated and non-viable with no replantable vessels, staged autologous or prosthetic reconstruction would be planned after wound care.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
Back to the Section 1 bank