All or part of the external ear may be avulsed, requiring careful patient management to restore the cosmetic appearance.
Patient selection: traumatic avulsion of the external ear, partially or totally
Parameters:
(1) incomplete avulsion (with intact skin pedicle) vs complete (without)
(2) availability of amputated segment (if detached)
(3) size of missing segment
(4) availability of microsurgical expertise
If incomplete avulsion has occurred, then there can be a direct re-attachment.
If the amputated segment is missing, then primary closure is performed with delayed secondary reconstruction with costal cartilage.
If the amputated segment is available and small (< 15 mm) and:
(1) if microsurgery is available, then perform microsurgical repair
(2) if microsurgery is not available, then direct attachment with hyperbaric oxygen therapy.
If the amputated segment is available and not (>= 15 mm) and:
(1) if microsurgery is available, then perform microsurgical repair
(2) if microsurgery is not available, then primary closure OR direct attachment with hyperbaric oxygen therapy.
If the initial repair is unsuccessful, then delayed secondary reconstruction is performed.
