Microsurgical ear replantation is a significant challenge because vessel sizes are diminutive. Furthermore, as ear vessels are larger in the medial portion than in the lateral portion, microsurgical replantation of a replant including only the helix is extremely difficult. The authors replanted a partial helix of the ear using a single arterial anastomosis. As no suitable veins could be identified, medicinal leech therapy and systemic heparinization were used to achieve venous drainage. The replanted helix survived completely and the cosmetic result was excellent. Microsurgical replantation should be considered the treatment of choice in helix amputation cases, even though amount of replant is small. (c) 2009 Wiley-Liss, Inc. Microsurgery 2009.