Long-Term Outcomes of Microsurgical Nasal Replantation: Review of the Literature and Illustrated 10-Year Follow-Up of a Pediatric Case with Full Sensory Recovery

Abstract

We present a case of successful artery only total nose replantation in an 18-month-old child, with 10 years of follow-up and full sensory recovery despite no nerve repair. The common absence of veins for anastomosis does not prevent successful replant, as demonstrated with the use of Hirudo medicinalis use in this unique case. We comprehensively review the literature of this rare and complex injury and advocate microsurgical replantation where possible over other methods of nasal reconstruction.

Reconstruction of a Nose Bitten and Eaten by a Dog

“…5,11 This is the first case of a successful replantation of an eaten and partially digested nose, performed in childhood after a dog bite.…”

“…5 Of note, the complete success of a replantation following a bite injury is achieved only in 3 cases. 5,6 Bite injuries are notorious for the damage they can cause to tissues.…”

“…5 Of note, the complete success of a replantation following a bite injury is achieved only in 3 cases. 5,6 Bite injuries are notorious for the damage they can cause to tissues. There is a high risk of infection due to the seeding of bacteria into deep structures, as well as the combined avulsion and the involved crush forces often cause segmental defects in the blood vessels.…”

Attempted Nose and Lip Replantation after Partial Animal Digestion

“…7 Vessels have successfully been used for arterial anastomoses in the supermicrosurgery range from 0.3 to 0.7 mm. [8][9][10][11] Although the majority of anastomoses are artery to artery, cases of successful revascularization of amputated segments by anastomosing an artery to an amputated segment vein have been reported, with veins ranging in size from 0.3 to 0.6 mm. [10][11][12] Although venous-to-venous anastomoses are preferred, there are several examples of identified arteries with back bleeding being sutured to veins as a method of venous outflow, all with successful outcomes.…”

“…[8][9][10][11] Although the majority of anastomoses are artery to artery, cases of successful revascularization of amputated segments by anastomosing an artery to an amputated segment vein have been reported, with veins ranging in size from 0.3 to 0.6 mm. [10][11][12] Although venous-to-venous anastomoses are preferred, there are several examples of identified arteries with back bleeding being sutured to veins as a method of venous outflow, all with successful outcomes. 9,13,14 Given the small size of vessels, vein grafting to generate tension-free anastomoses outside the zone of injury is often required, with the longest recorded at 13cm.…”