Ear Replantation

Ear Replantation

Did all you comic book fans get your geek on in tonight's episode? 

How crazy and fun were all those patients?! The set was jumping that day – jumping with extras totally psyched to wear their own super-hero costumes. I've never been to a comic book convention, but I imagine it would be a good time. Which is probably what these folks were having until the autographed Tardis unleashed a human stampede, causing trampling injuries a-plenty. Like poor Keith. Not only did he suffer from a painful spinal fracture, but he also lost an ear! A personal note: I really wanted Greg, Keith's friend, to find the severed ear on the bottom of a Storm Trooper's shoe…

How the heck does an ear even get ripped off?

Well, amid the human stampede chaos, Keith's head somehow got stuck on someone's costume, causing the ear to be severed. And it should be noted that traumatic auricular amputation is a rare event. But other examples in the literature include bites (animal and human), industrial accidents, falls, and automobile accidents.

Trauma of the ear, especially amputation, presents a striking and aesthetic deformity to the patient. While the ear injury obviously takes second place to other life-threatening injuries, the site should be evaluated as soon as possible because the deformity can also lead to psychological problems for the patient.

When a patient with a severed ear comes in, barring spinal fractures or other trauma, what are the main concerns?

First, is the detached ear available? If so, the amputated auricle should be placed in a plastic bag on ice and brought to the hospital with the patient. The patient will be started on intravenous antibiotics to prevent infection. For example, if the ear were bitten off, there may be potential for contamination by bacteria from oral flora.

In these cases (where the ear is immediately available), the patient usually will be taken to the operating room for attempted replantation within a few hours of arrival. Instances of replantation of the ear have been reported since 1980. The preferred method for reattachment involves three types of microsurgical techniques: vein grafts, primary vascular repair, and repair by means of pedicled superficial vessels.

However, several medical centers do not choose one of the microsurgical methods because of the inadequate availability of appropriate veins, lengthy operative time, and technical complexity. These centers opt for a simpler reattachment such as a composite graft. And due to the possibility of necrosis and loss of the organ, they have developed ways to improve the "take" of the replantation such as creating a retroauricular pocket for the cartilage to improve its vascularity.

In Keith's case, since they didn't have the ear until nearly twenty-four hours later, the surgeons' options were more limited. Mark and Jackson initially wanted to immediately get him into the OR to try for reattachment, but then Keith re-injured his spine during his argument with Greg. Since Derek needed to evacuate the epidural bleed first, Jackson proposed implanting the ear into Keith's abdomen to preserve its viability for reattachment at a later time.

If Greg hadn't found the ear, what were Mark and Jackson planning?

Mark and Jackson initially had been examining Keith in order to construct a new ear, made from cartilage taken from his ribs. They would have based their framework by modeling it after the other uninjured ear. The success of reconstruction depends on a variety of factors such as adequate blood flow to the graft as well as the availability of soft tissue. Without sufficient soft tissue (Keith actually lost a good amount), the surgeon will have difficulty with repair and creating a flap.

For more information on ear emergencies, please visit the following link: