Microsurgical lip replantation: Evaluation of functional and aesthetic results of three cases

Abstract

Lip amputations are rare, and microsurgical replantation must be systematically tried to restore form and function in one step. The authors present a series of three cases. Revascularization of the amputated segment was obtained by arterial anastomosis with the corresponding labial coronary artery. No venous anastomosis was carried out, because no vein could be identified. Venous drainage was obtained by inducing bleeding and by postoperative application of leeches for 6 days. Anticoagulant therapy and antibiotherapy were used for 10 days. With this approach, two lip amputations were completely saved, and a third amputation only suffered partial necrosis. Aesthetic and functional results were evaluated as being good, with reestablishment of labial continence and recovery of protective sensitivity.

Retrospective analysis of facial dog bite injuries at a Level I trauma center in the Denver metro area

“…The restoration of venous drainage could not be performed because there were no veins accompanying the labial artery. 16 Therefore, leech therapy was required for approximately 1 week until collateral circulation developed to support adequate venous drainage. In the absence of a suitable artery in the amputated segment, successful replantation can be performed in some instances using arterialized venous anastomosis technique, should a suitable vein in the amputated lip segment exist.…”

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

“…In the largest series, Walton et al 1 published a review of 13 replants from 12 institutions. Duroure et al 2 published a series of three cases in France and the remaining publications are single case studies. [3][4][5][6][7][8][9][10] In all, 24 cases of successful lip replantation have been reported in the English literature.…”

Medicinal leeches for surgically uncorrectable venous congestion after free flap breast reconstruction

“…A large systematic review showed that 50% of patients receiving leech therapy also require blood transfusion . Among those receiving blood, transfusion requirements range from two to 29 units . For an individual patient, use of 350 leeches and transfusions of 29 units have been reported .…”

“…Leeches have been used to salvage many types of reconstructive procedures, including ear replantation, lip replantation, nasal skin avulsion, penile replantation, nipple congestion after elective breast surgery, and head and neck reconstruction . High salvage rates (>90%) of congested skin flaps and local flaps can be expected .…”

“…In the setting of venous congestion, blood withdrawl by leech is actually of secondary importance as the ongoing ooze is believed to be the principal mechanism for flap decongestion. 4 Leeches have been used to salvage many types of reconstructive procedures, including ear replantation, 5,6 lip replantation, 7 nasal skin avulsion, 8 penile replantation, 9 nipple congestion after elective breast surgery, 10 and head and neck reconstruction. [10][11][12][13] High salvage rates (>90%) of congested skin flaps and local flaps can be expected.…”