Total lower lip and chin replantation following a trampoline accident: Rescue surgery with intensive leech therapy
Sounthakith V, Schweitzer-Chaput A, Picard A, Prebot J, Galland A, Neiva-Vaz C, Khonsari RH (2026) · Journal of Stomatology, Oral and Maxillofacial Surgery · n=1
Study Profile
- Design
- single pediatric case report of total lower lip and chin replantation following a trampoline accident requiring rescue microsurgical management with arterial-only inferior labial artery anastomosis and intensive medicinal leech therapy in the absence of venous anastomosis (Department of Maxillofacial Surgery and Plastic Surgery, Necker - Enfants Malades Hospital AP-HP, Paris Cite University, Paris, France)
- Sample size (n)
- 1
- Intervention
- Inferior labial artery anastomosis with intensive medicinal leech therapy as the primary venous drainage strategy in the absence of successful venous anastomosis; arterial revisions performed but venous drainage not reestablished; supplemental local-flap reconstruction (Karapandzic and Camille Bernard flaps) plus mesotherapy and nanofat injections performed one month later
- Comparator
- Not applicable - single-patient pediatric case report; comparison to alternative replantation strategies is narrative only
- Primary endpoint
- Survival of the replanted lip and chin segments and residual functional/cosmetic outcome
- Primary result
- Partial survival was achieved despite intensive leech therapy and arterial revisions: 75% of the replanted lip and 25% of the replanted chin were lost by postoperative day 14; subsequent reconstruction with combined Karapandzic and Camille Bernard local flaps plus mesotherapy and nanofat injections was performed at one month; outcome was marked by residual microstomia; authors emphasize the critical role of leech therapy in this arterial-only pediatric replantation scenario and the essential collaboration with intensivists, pharmacy, and pediatric anesthesia
- Follow-up duration
- minimum 1-month follow-up plus subsequent staged reconstruction
- PMID
- 41513071
Key Findings
- First published European pediatric case of total lower lip and chin replantation with intensive medicinal leech therapy as primary venous drainage strategy
- Highlights that leech therapy is critical when venous anastomosis cannot be reestablished
- Partial survival outcome (25% lip, 75% chin loss) reflects the difficulty of managing the large surface area and pediatric vascular anatomy
- Required staged reconstruction with local flaps (Karapandzic, Camille Bernard) plus mesotherapy and nanofat injections
- Demonstrates that successful pediatric replantation under K040187 indication requires multidisciplinary collaboration (microsurgery, pediatric anesthesia, intensivist, pharmacy)
Limitations
- Single case (n=1) - cannot establish generalizable efficacy
- Pediatric population - results may not generalize to adult lip replantation
- Partial-survival outcome highlights limits of leech therapy when arterial-only flow cannot sustain large tissue volumes
- No quantitative leech dosing protocol detailed
- Long-term cosmetic, sensory, and functional outcomes not yet reported
Clinical Implications
Sounthakith 2026 documents the first published European pediatric case of total lower lip and chin replantation with intensive medicinal leech therapy. For US clinicians performing emergency pediatric facial replantation under the K040187-cleared indication, the case illustrates the critical role of medicinal leech therapy when venous anastomosis cannot be achieved, while also highlighting the practical limits of arterial-only replantation for large tissue volumes. The case reinforces the necessity of multidisciplinary planning (microsurgery, pediatric anesthesia, intensive care, pharmacy) and the institutional readiness required for K040187 pediatric microsurgical salvage. The trial complements Pertea 2021 (ear), Facchin 2018 (ear review), and Secanho 2024 (nose SR) in framing the arterial-only replantation literature.
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