Quick answer
An ear torn off in an accident usually has six to eight hours before replantation becomes impossible. A 35-year-old man arrived at Shanghai Ninth People's Hospital with his right ear 20 hours after it was avulsed, and with the arteries at the side of his head torn away. Wang Tingliang's team did not try to sew it back. They banked it on the dorsum of his foot — restoring its blood supply through foot vessels — kept it alive for nine days, and then replanted it to the head using a long vein graft on 22 June 2026 [1][2].
Key takeaways
- The ear was completely avulsed on 11 June 2026 and arrived 20 hours later, stored cool but not frozen [2][3].
- Standard ear replantation has a 6–8 hour window; 20 hours is far outside it [1][2].
- The superficial temporal vessels at the head were completely torn, leaving no recipient vessels [1].
- Stage one attached the ear to foot vessels, using a double-vein anastomosis to secure drainage [2].
- Stage two, nine days later, used the facial artery and vein with a 12–14 cm pedicle [2][5].
Why the obvious operation would have failed
Replantation needs healthy recipient vessels. In this case the temporal artery and vein had been ripped out at their roots, so there was nothing at the head to connect to; forcing an anastomosis would have produced thrombosis and necrosis. The ear itself, however, had been kept cold and its tissue was still viable [1][3].
The team's solution was a two-stage "ectopic banking": first rebuild the ear's blood supply somewhere with spare vessels — the foot — and only later move it back. The first operation cleaned the wound, dissected ear vessels under a millimetre in calibre, and joined them to branches on the dorsum of the foot. Because venous congestion is the usual cause of failure in such flaps, they anastomosed two veins, one for each drainage territory. The ear turned from pale to pink within hours [2][5].
The second stage
Nine days of round-the-clock monitoring — skin colour, temperature and capillary refill — kept the banked ear stable. On 22 June the team returned it to the head. The original vessel stumps had occluded, so they switched to the facial artery and vein and harvested a 12–14 cm vascular pedicle to bridge the distance, then performed multiple ultra-fine anastomoses [2][5].
This is one patient treated by an experienced ultra-microsurgery team, not a series with outcomes. The approach — ectopic banking, then transfer — is established in reconstructive surgery for amputated parts that cannot be replanted immediately, but it demands vessels of 0.2–0.8 mm, prolonged monitoring and a patient able to tolerate two operations. It also requires the avulsed part to have been preserved properly [1][2]. The hospital describes this as an uncommon combination — avulsion far beyond the window plus destruction of the recipient vessels — and one of the more complex ear replantations its team has handled [4].
The condition in context: ear avulsion
Ear avulsion is uncommon but functionally and psychologically significant, and outcome depends on how the part is handled before arrival.
| Region | What the data shows | Source |
|---|---|---|
| Time window | Replantation is usually attempted within 6–8 hours of avulsion [1][2]. | China News / Xinmin [1][2] |
| Preservation | The ear was kept in a sealed bag in ice water — cool, not frozen — which preserved tissue viability [3]. | The Paper [3] |
| Vessel size | Ear vessels are extremely small: the artery about 0.8 mm, some veins 0.2–0.5 mm [5]. | Toutiao [5] |
For bystanders, the practical lesson is preservation: wrap the part in clean gauze, seal it in a bag, and place that bag in ice water — never directly on ice — and get to a microsurgery centre fast [3].
Why it matters
| For the patient | What the report suggests | Source |
|---|---|---|
| Appearance | Replantation avoids the need for a prosthetic or rib-cartilage reconstruction [1]. | [1] |
| Function | An autologous ear keeps its shape and sensation better than a reconstruction [1]. | [1] |
| Caution | Requires two operations and sub-millimetre anastomoses at a specialist centre [2][5]. | [2][5] |
Availability and limits
- This is an editorial summary of hospital and media reports, not a treatment recommendation [1][2].
- It is a single case; success rates for this approach are not reported [2].
- Outcomes depend on how the avulsed part was stored and how quickly the patient arrives [3].
- Two operations and prolonged monitoring are required [2].
- The technique needs ultra-microsurgical expertise not available everywhere [1][4].
What to ask before booking
| Question | Why it matters |
|---|---|
| Was the avulsed part stored correctly? | Cool, not frozen, in a sealed bag in ice water preserves viability [3]. |
| Are there usable recipient vessels at the site? | If not, ectopic banking may be the only route [1]. |
| Which department handles foreign patients, and in what language? | Shanghai Ninth People's Hospital is a working hospital we do not book; confirm international-department coordination and language support. |
| What monitoring and second-stage plan are needed? | The approach is explicitly two-stage [2]. |
Questions patients ask
What happened in this case?
A man's right ear was completely avulsed and arrived 20 hours later; with no usable vessels at the head, surgeons first attached it to foot vessels, then replanted it nine days later [1][2].
Why not replant it immediately?
The temporal vessels had been torn out at the root, so there was nothing to anastomose to; immediate replantation would likely have failed [1].
What is 'ectopic banking'?
Temporarily attaching an amputated part to another site with spare vessels to keep it alive until it can be moved back [2].
How was the ear preserved before arrival?
In a sealed bag in ice water — cool but not frozen — which kept the tissue viable despite the delay [3].
Is this relevant to international patients?
It is useful context for China's microsurgery. Shanghai Ninth People's Hospital is a working hospital we do not book — contact its international department directly [1].