Is Simple Reimplantation a Viable Option in Pediculated Auricular Avulsions? A Systematic Review of the Literature.

Abstract

Auricular avulsion injuries are rare, and microvascular reimplantation is considered the preferred treatment according to current literature. However, when a small skin pedicle is preserved, non-microvascular reattachment techniques may offer comparable outcomes. This systematic review aims to assess whether these techniques could represent a viable alternative. We analyzed 32 cases of pedicled auricular avulsion reported in 16 articles, focusing on patient demographics, injury mechanisms, pedicle characteristics, venous congestion, and postoperative management. Venous congestion occurred in 11 patients, with a significantly higher risk in narrower pedicles (mean width 9.82 mm; 95% CI: 4.75-14.89; p = 0.025). Prophylactic heparin significantly reduced this risk (p = 0.007). Other interventions-leech therapy and hyperbaric oxygen-lacked sufficient data for firm conclusions. Most cases achieved graft survival; necrosis occurred in some, and only two patients required additional surgery. Non-microvascular techniques appear to be a viable alternative to microvascular reimplantation, with similar results and potentially fewer complications. Venous congestion remains the main challenge, requiring active management and hospitalization for monitoring. Limited case series and publication bias still hinder the development of standardized guidelines.