Use of arterialization of the venous system in reattachment of the avulsed auricle.

We attempted to demonstrate that the totally amputated rabbit auricle could survive on nutrient flow provided through arterialization of the venous system. It has been demonstrated by Mundy and Panje that a free flap placed on a large recipient bed and receiving nutrients through retrograde venous flow will survive as frequently as one in which a conventional microvascular anastomosis has been performed. Our groups examined (1) conventional microvascular anastomosis of the amputated appendage to establish survival and demonstrate proficiency with the technique; (2) survival when only venous egress is maintained; and (3) effectiveness of establishing nutrient flow through arterialization of the venous system. Nutrient flow in the first group was through the arterial system. In the second group no nutrient flow was established, but the venous system remained intact. In the last group, nutrient flow existed through retrograde venous profusion. Survival within the groups that underwent reestablishment of nutrient flow through a conventional reanastomosis or through arterialization of the venous system was not significantly different. There were no surviving segments if nutrient flow was not reestablished, but venous channels remained intact. It was shown that nutrient flow to a free-standing appendage can be established through retrograde venous profusion, and that maintenance of venous drainage alone is not sufficient for survival when a limited base exists. We suggest that arterialization of the venous system is a viable means of reestablishing nutrient flow to the amputated auricle.