Replantation of the avulsed pinna: 100 percent survival with a single arterial anastomosis and substitution of leeches for a venous anastomosis.

We have presented an alternative form of management for the difficult ear replant in which conventional venous outflow cannot be reestablished. Early and aggressive medicinal leeching provided an excellent means of venous decompression until neovascularization had taken place. The primary use of leeches in such small composite replants may be superior to the time-consuming and technically difficult exercise of trying to find and anastomose suitable veins. In selected patients this technique may allow successful replantation of the amputated ear, thereby providing a superior aesthetic result to most forms of secondary reconstruction.