Total auricular amputation salvage: A case report on the retro auricular pocket technique and review of alternative approaches

Management of auricular amputation presents significant reconstructive challenges, requiring a delicate balance between aesthetic outcomes and tissue preservation. We present a case demonstrating successful implementation of the retro auricular pocket technique for auricular reattachment. A 29-year-old male patient presented to our emergency department with complete auricular amputation following a car accident. Initial examination revealed a clean amputation with preserved auricular architecture. The amputated segment was managed according to standard preservation protocols. Following careful evaluation, we elected to utilize the retroauricular pocket technique as described by Mladick et al., rather than microvascular reconstruction. Surgical Technique and Management: The procedure involved meticulous deepithelialization of the amputated cartilage, followed by precise reattachment to the amputation stump and subsequent burial in a retroauricular skin pocket. The postoperative protocol included broad-spectrum intravenous antibiotics, systematic anticoagulation, and careful monitoring of tissue perfusion. Outcome: The patient demonstrated excellent graft uptake with satisfactory aesthetic results. Follow-up at 3 months showed maintained auricular architecture with acceptable cosmetic appearance. This case highlights the efficacy of the retroauricular pocket technique as a viable alternative to microvascular reconstruction in selected cases of auricular amputation. The technique's success relies on maximizing the nutrient-tissue interface while preserving options for future reconstruction if needed.