Microvascular Replantation Following Facial Dog Bites in Children

Williams, Amanda; Powers, Jeremy M.; Rhodes, Jennifer; Pozez, Andrea L.

doi:10.1097/sap.0000000000001485

Cited by 9 publications

(4 citation statements)

References 20 publications

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“…Two series report successful vein-vein connection in only 47%-53% of cases. 3,9 Our case joins these reports in emphasizing the role of leeches in preventing venous congestion.…”

Section: Discussionsupporting

confidence: 73%

Posttraumatic Lip Replantation in a Pregnant Woman

Caragher

Hwang

Gardenier

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Traumatic lip amputation is a devastating injury. No other tissue replicates its unique histology, often limiting the reconstructive outcome. Replantation is a technically challenging procedure, requiring extensive postoperative optimization, including systemic anticoagulation, leech therapy, significant blood loss, and antibiosis. Given the rarity of replantation in the context of pregnancy, there are no documented accounts of lip replantation in pregnant patients. We report a case of a 25-year-old pregnant woman who sustained an avulsion injury of the right upper lip from a dog bite. The patient presented with the amputated lip and emergent microvascular replantation was performed. Postoperative course consisted of management of controlled yet significant blood loss through leech therapy and close collaboration with obstetric colleagues. The patient was ultimately discharged with successful cosmetic and functional outcome and, importantly, with maintenance of a healthy pregnancy.

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“…Two series report successful vein-vein connection in only 47%-53% of cases. 3,9 Our case joins these reports in emphasizing the role of leeches in preventing venous congestion.…”

Section: Discussionsupporting

confidence: 73%

Posttraumatic Lip Replantation in a Pregnant Woman

Caragher

Hwang

Gardenier

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…Furthermore, maintaining outflow of venous drainage can also be difficult. To solve this problem, leeches have been employed to prevent venous congestion and anticoagulants have been implemented to prevent thrombus formation [8]. Unfortunately, we are unable to determine if thrombosis developed in our patient because immediate revision and exploration were subsequently cancelled due to the post-operative stroke and STEMI.…”

Section: Discussionmentioning

confidence: 94%

“…Establishing venous anastomosis with an adequate flow in the upper lip is technically challenging because the superior labial vein is frequently a venous plexus [6][7]. Additionally, the crush and shear forces associated with a bite can result in extensive damage to the venous intima further complicating the establishment of good venous drainage [7][8][9]. Furthermore, maintaining outflow of venous drainage can also be difficult.…”

Section: Discussionmentioning

confidence: 99%

Complications of Microvascular Upper Lip and Free Grafted Nasal and Eyebrow Replantation After Assault via Human Bite

Leach¹,

Lundberg²,

Holcombe³

2019

Cureus

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Amputation of facial soft tissue, particularly avulsion due to human bite, is an uncommon injury that has severe cosmetic and functional implications. Microsurgical replantation has the potential for superior aesthetic outcomes and restoration of function. We report a case of a 46-year-old male who sustained avulsion injuries from human bites, which included portions of his eyebrow, nose, and upper lip. Artery and vein microvascular replantation was performed on the upper lip. The amputated eyebrow and nasal segments were replanted in a similar fashion to a skin graft. On post-operation day 1, our patient suffered an ischemic stroke followed by a myocardial infarction requiring systemic tissue plasminogen activator (tPA) treatment. Following administration of tPA, there was continuous bloody discharge from the replant sites and the eyebrow, nose, and upper lip began to appear increasingly dusky. Our patient was determined to be a high-risk candidate for immediate revision surgery and he subsequently underwent a six-stage secondary reconstruction. At his most recent four-month follow-up, our patient is satisfied with his cosmetic and functional outcomes. This was a case of failed microvascular upper lip replantation and eyebrow and nasal replacement complicated by stroke and myocardial infarction. The authors review the common complications in replantation, particularly pertaining to upper lip reanastamosis, and discuss a potential novel complication encountered in this case relevant to both free graft and microvascular replantation.

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“…Para la reconstrucción, el cirujano dispone de varias herramientas englobadas en algo comúnmente llamado la escalera reconstructiva, una apología que hace referencia a un protocolo que se debe seguir, iniciando por los procedimientos más sencillos como el cierre por primera o segunda intención, hasta llegar a los colgajos microquirúrgicos. 5 Los colgajos locales son usados en la reconstrucción nasal por tener apariencia y caracterís-ticas dérmicas similares, y son superiores a los injertos cutáneos, por una mejor integración dada su preservación vascular. 6 Para la decisión reconstructiva de nuestro paciente se tomaron en cuenta varios factores, principalmente la afectación de varias unidades estéticas; la edad del paciente, la presencia de cobertura interna y la integridad de la estructura cartilaginosa, así como el tratamiento previo desconocido, por lo que se optó por un colgajo frontonasal por su aporte sanguíneo seguro y características dérmicas similares.…”

Section: Discussionunclassified