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Doctors Combine Modern Microsurgery and Ancient Leeching To Save Ear

September 24, 1985 GMT

BOSTON (AP) _ Doctors have combined sophisticated microscopic surgery with the ancient art of leeching to accomplish the rare, successful reattachment of a child’s severed ear.

Compared to reattaching hands, fingers and other severed appendages, putting back an ear is extremely difficult, because the blood vessels that supply the ear are so tiny.

Doctors said the surgery is only the second recorded instance in which they successfully reattached blood vessels to restore the flow of blood and save a severed ear.

The 12-hour operation was conducted under microscopes that magnified 40 times, and it involved reconnecting torn veins and arteries so small that they are invisible to the naked eye.

Occasionally ear reattachments are performed without hooking up the blood vessels. New capillaries grow into the ear, but this hardly ever works.

In this case, the operation was complicated by poor circulation. Blood flowed into the ear, but because of clots in the veins, it failed to flow back out again. So doctors put leeches on the patient’s ear, and the worms sucked out the stagnant blood.

The strategy worked. The patient, 5-year-old Guy Condelli of suburban Medford, was discharged from the hospital about two weeks after the operation and is now going to kindergarten.

″His ear looks terrific,″ his mother, Darlene, said Tuesday.

Her son lost his ear Aug. 16 when he was attacked by a dog. Guy and his ear were sent to Dr. Joseph Upton, a surgeon at Children’s Hospital in Boston, for possible reattachment.

″I decided to give it a try, even though the success rate is almost nil because the blood vessels are so small,″ Upton said.

Using threads so small that it takes two of them to sew together a human hair, Upton painstakingly reconnected the veins and arteries and reattached the torn ear.

Three days after the operation, however, clots started to form. The ear turned blackish-blue with congested blood.

At first, doctors gave the child heparin, a medicine that prevents clotting, and made cuts in the ear to let out blood. However, the child was losing large amounts of blood, and doctors feared the operation would fail.

As a surgeon in Vietnam, Upton had sometimes used leeches to heal wounds, and he decided they were worth a try.

″I started calling around the country to my friends trying to find some hungry leeches,″ Upton said. He eventually found a variety of medical leeches in England and had some flown to Boston.

He attached two of the 11/2 -inch worms to the child’s ear. They slowly filled up with blood and eventually became 8 inches long and looked something like fat cigars.

Besides sucking blood, the leeches inject an anesthetic and anticoagulant into the flesh to keep blood from clotting.

″The ear perked up right away,″ Upton said. ″It was obvious it was going to work.″

The doctors continued the therapy for a week and used up about two dozen leeches. By that time, normal circulation was restored in the child’s healthy- looking reattached ear.

″It wouldn’t have worked if we hadn’t been able to use the leeches,″ Upton said.

″I said, ’If it works, do it. Whatever it takes,‴ Mrs. Condelli said. ″He put the leeches on, and it was incredible how much better it looked.″

Upton said leeches are occasionally employed for finger reattachments in France but are rarely used in the United States.

Dr. Richard Wolfe, a medical historian at Harvard, said leeches have been used since ancient times to draw bad blood from wounds, but they fell from favor in the mid-1800s.

The child did not seem to mind the leeches and could not feel them, said Upton. And the tedious surgery and difficult recovery were far better than the alternative of losing the ear.

″People ask me, ’Why do this?‴ he said. ″There are many ways to reconstruct ears, but nothing comes close to approximating the original part.″