Partial salvage of avulsed tissue after dog bite

Øregaard JS, Lang CL, Venzo A (2015) · Annals of the Royal College of Surgeons of England · n=1

RCT evidence detailTrial reference

GRADE Very LowInsufficient evidenceCondition: Microsurgical Replantation (Digit / Ear / Scalp) →

This trial (highlighted) by sample size alongside other indexed Microsurgical Replantation (Digit / Ear / Scalp) trials. Larger trials generally carry more statistical weight.

Study Profile

Design: single-patient case report (18-year-old woman, central facial dog bite injury, Rigshospitalet Copenhagen)
Sample size (n): 1
Intervention: Microsurgical arterial anastomosis for nasal tip replantation with leech therapy when venous anastomosis impossible; skin necrosis subsequently managed with revision and full-thickness skin graft
Comparator: No control - case report
Primary endpoint: Nasal tissue salvage and aesthetic outcome after dog bite avulsion
Primary result: Partial nasal salvage achieved through arterial-only anastomosis with leech therapy; subsequent skin necrosis required revision with full-thickness skin graft; satisfactory cosmetic and functional result at 8-month follow-up
Follow-up duration: 8 months postoperative
PMID: 26673050

Key Findings

Facial dog bite avulsion salvage with arterial-only anastomosis + leech
Subsequent skin necrosis required revision
Healthy tissue immediately below necrotic skin enabled FTSG closure
Satisfactory 8-month aesthetic outcome
Demonstrates leech utility in facial reconstruction context

Limitations

Single case - limited generalizability
Partial necrosis suggests leech alone insufficient
8-month follow-up may not capture long-term outcomes
Subjective cosmetic assessment
Cannot quantify leech contribution to partial salvage

Clinical Implications

Øregaard 2015 documents leech therapy's role in facial dog-bite avulsion salvage. For US clinicians under K040187, the case demonstrates the device's utility in facial trauma beyond ear replantation - specifically, when arterial-only anastomosis is necessary because no suitable veins are available for primary anastomosis. The eventual need for FTSG revision shows leech therapy is not a panacea.

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