Lip replantation and delayed inset after a dog bite: A case report and literature review

Abstract

Dog bites to the face are common in children and often involve amputation of the lip or cheek resulting in a devastating facial injury. When feasible, replantation of the amputated lip segment provides the optimal cosmetic outcome. Here, we present the case of a partial upper lip replantation with delayed inset as a new treatment option. Revascularization of the central upper lip segment was enabled by anastomosis to a single labial artery. Inset compression at the time of initial closure caused arterial insufficiency. Therefore, a delayed, sequential inset was performed over the following 2 weeks resulting in an esthetically and functionally successful replantation. A comprehensive review of the literature on published lip replantation techniques is also provided and discussed. We add delayed inset to the armamentarium of the microsurgeon when faced with these difficult injuries.

Surgical Management of Animal and Human Maxillofacial Bites: A Comprehensive Review

“…54,70 The central region must be handled first because of a more complicated surgical management. 7,14,47,54,66 Facial wounds that are not sutured can result in severe unaesthetic and functional damage. 9,18,35,41,51,54,70,72 Spaces between stitches on the skin can be useful to enable for spontaneous drainage, 72 a suitable option for scar reduction.…”

“…14,65,69 In the event of tissue avulsion, replantation must be considered as the first option. 7,15,23,64,66,70,74 Not only aesthetic complaints but also functional problems are very often encountered. 73 When cartilages such as nose and ear are affected, another cartilage can serve to allow further reconstruction.…”

Pediatric Lip Replantation: A Case of Supermicrosurgical Venous Anastomosis

“…Lip replantation has been performed in a younger population with a mean age of 24.8 years, 1 but only six upper lip replanted cases were performed in pediatric population (►Table 1). 3,[5][6][7][8][9] A common finding in almost every case reported is that, after re-establishment of arterial inflow, the venous drainage seemed to be most critical and problematic. 1,2,6 Overall, only in 13 cases (41.9%) a venous anastomosis could be accomplished, presumably from the inability to find veins in the lip fragment, or in the surrounding facial subcutaneous.…”

“…3,[5][6][7][8][9] A common finding in almost every case reported is that, after re-establishment of arterial inflow, the venous drainage seemed to be most critical and problematic. 1,2,6 Overall, only in 13 cases (41.9%) a venous anastomosis could be accomplished, presumably from the inability to find veins in the lip fragment, or in the surrounding facial subcutaneous. 1 In pediatric cases, this rate was a little higher, 66%, which may due to bigger amputated fragments in this population, that usually included more facial tissues with the upper lip, and probably carried more proximal and larger caliber veins (►Table 1).…”

Soft Tissue Management in Facial Trauma

“…The small caliber of the superior and inferior labial artery and vein make lip replantation difficult, and venous outflow often becomes an issue. 25 During the initial surgical exploration of the amputated lip, the identification and anastomosis of suitable vessels is attempted. Successful reports of lip replantation in the literature have anastomosed the artery and vein, artery only, 26 vein only, 27 or have attached the artery to the vein for a "flow-through" replant 28 for venous outflow.…”