title: A comparison of ear reattachment methods: a review of 25 years since Pennington.
abstract: BACKGROUND
  A failed ear reattachment tends to complicate subsequent reconstruction with autogenous rib cartilage. The various reattachment methods differ in technical demand, in the secondary damage of periauricular tissue, and in aesthetic outcome. In the past 25 years, the microsurgical method has proven to be especially successful. The aim of this work was to assess case reports of auricular trauma since the first microsurgical ear replantation by Pennington.
  
  
  METHODS
  An extensive review of the literature of acute ear trauma published between 1980 and 2004 was performed. For a better comparison, the type of damage, the reattachment technique, and the final outcome were categorized. Representative cases of traumatic auricular lesions, which were reconstructed with rib or conchal cartilage at the authors' hospital, were included.
  
  
  RESULTS
  Seventy-four cases in 56 publications were analyzed. The microsurgical replantation showed excellent aesthetic results but demanded an intensive perioperative and postoperative treatment. Pocket methods were used mainly in partial amputations. Repairs with periauricular tissue flaps made a quite inconsistent impression. Direct reattachments, such as composite grafts, were indicated only in extended lacerations.
  
  
  CONCLUSIONS
  To replant an avulsed auricle is still a challenge for surgeons. Microsurgically reanastomosed ear replantation appears to be the best method because a superior outcome can be achieved without jeopardizing a subsequent ear reconstruction with rib cartilage in case of failure. The pocket method and periauricular skin or fascia flaps should be abandoned. They rarely achieve such a consistently good aesthetic outcome as a secondary reconstruction with rib cartilage.
authors.affiliation: Luebeck, Germany From the Department of Otorhinolaryngology, University of Schleswig-Holstein Campus Luebeck.
authors.forename: Armin
authors.initials: A
authors.lastname: Steffen
authors.forename: Ralf
authors.initials: R
authors.lastname: Katzbach
authors.forename: Susanne
authors.initials: S
authors.lastname: Klaiber
mesh_terms: D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery; D002356:Cartilage / Q000637:transplantation; D002648:Child; D002675:Child, Preschool; D004425:Ear Cartilage / Q000293:injuries / Q000601:surgery*; D004426:Ear Deformities, Acquired / Q000601:surgery*; D004431:Ear, External / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D012272:Ribs; D014182:Transplantation, Autologous; D016896:Treatment Outcome