Introducing a novel technique for auricular replantation following subtotal amputation combining Sexton and Mladick pocket methods: a case report

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BACKGROUND: Traumatic auricular amputations present a unique surgical challenge, particularly in cases where microsurgical anastomosis is not feasible due to vessel damage or absence. Traditional reconstruction techniques often yield suboptimal aesthetic or functional results. The pocket technique, as described by Sexton and Mladick, has shown promise in such scenarios, particularly in partial auricular amputations. CASE PRESENTATION: We report a case of a 52-year-old Caucasian male who presented with traumatic amputation of the cranial third of the auricle following a dog bite. The injury was classified as grade III according to the modified Laskin and Donohue grading system. Owing to the absence of suitable vessels for microsurgical repair, a two-stage reconstruction using a novel modification of the pocket technique was performed. In the first stage, under general anesthesia, the skin was carefully dissected from the amputated auricular cartilage, which was then cleaned, debrided, and sutured to the remaining auricle using an "8"-pattern suture technique. A retroauricular advancement flap, adapted from Mladick's method, was utilized to create a vascularized pocket for the cartilage. After 2 months, the auricle was elevated from the mastoid, and a full-thickness skin graft was applied to cover the defect. A galea advancement flap, based on the posterior branches of the superficial temporal artery, was harvested to provide vascular support and refine the auricular contour. CONCLUSION: This case demonstrates the successful application of a modified pocket technique that synergistically integrates principles from Sexton and Mladick's approaches. The result was a well-perfused, anatomically contoured, and aesthetically pleasing auricular reconstruction without the need for microsurgical anastomosis. This technique represents a viable reconstructive alternative in select cases of partial auricular amputation where vessel quality or availability is compromised.

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