|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| Replantation of the amputated ear is sometimes possible, but it is difficult to find suitable vessels, particularly veins for repair. Vein-grafting the vessels of the amputated part on a side table before replantation simplifies vascular repairs, and repairing the artery first may facilitate identification of additional veins for repair. Venous congestion usually occurs and may respond well to leeching.
Reconstruction with composite grafting of the pinna has occasionally been successful, but is not usually reliable. Excising the cartilage, however, allows a greater contact surface with the wound bed and may improve the chances for revascularization. If revascularization is achieved, venous congestion will follow. This is best treated with medicinal leeches. Another technique for enhancing the possibility of survival of a free graft is to denude the cartilage and bank it under the scalp skin to be covered later with a skin graft, or with temporalis fascial flap with a skin graft.62
Dressings protect the replant, absorb wound drainage, and prevent desiccation and maceration of the tissue. 63 Thus, the wound requirements govern the dressing techniques.
Protection is enhanced by careful splinting with either plaster splints or bulky pillow splints that immobilize and cushion the replanted part. The wound edges are dressed with nonconstricting Xeroform gauze.
Dressing changes should be limited to avoid undue manipulation of replant, which may cause vasospasm. Nevertheless, clotted blood in a gauze bandage can quickly cause a constricted dressing, especially if there is postoperative edema. Therefore, change bloody dressings frequently and inspect them for potential compression and constriction. Elevate the replanted part to minimize edema and prevent venous congestion. A room temperature of 33°C is maintained, and a sterile towel is placed over the replanted extremity and covered with a heating pad (40°C for 5 to 7 days to encourage vasodilation and circulation (see Chap. 35 for perioperative care).
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