American Society of Hirudotherapy

Microvascular replantation of a composite facial avulsion in a 24-month-old child after dog bite

Case report published in Microsurgery (2017)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportClinical TrialsMacias D et al. · Microsurgery, 2017

Abstract

Dog bite injuries are common sources of morbidity with an estimated incidence of 4.5 million bites per year with over 350,000 requiring treatment in the emergency room. Children under the age of 14 are most likely to be affected with a peak age of 5-9 years old. We report a case of a 24-month-old female who sustained a large composite facial avulsion injury from a pit bull dog bite. The avulsed tissue involved a substantial portion of the patient's mid-face, including the entire soft tissue of the nose, upper lip, part of the left cheek, and left oral commissure. Artery-only microvascular replantation was performed because no recipient vein could be identified from the facial defect. Medicinal leech therapy was used for eight days postoperatively to prevent venous congestion. The patient experienced significant blood loss due to leech therapy and required nearly 29 L of blood product replacement. At the last follow up of 8 months postoperatively, the patient was recovering well with significant improvement in function and cosmesis of the mid-face. This case describes a successful artery-only replantation of an avulsive bite injury to the face of a young child. Despite the technical difficulty of cases such as this one, microvascular replantation should be attempted because when successful it provides a superior cosmetic and functional result to other reconstructive techniques.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeCase ReportsJournal Article
Indexed MeSH termsAmputation, TraumaticAnimalsBites and StingsDogsEstheticsFacial InjuriesFemaleFollow-Up StudiesHumansInfantInjury Severity ScoreMicrosurgery

Summary

24-month-old female with extensive mid-face avulsion (nose, upper lip, cheek) after pit-bull bite. Artery-only microvascular replantation with 8-day leech therapy required ~29 L blood-product replacement, achieving successful cosmetic and functional recovery at 8 months.

Why This Matters for Hirudotherapy

This case report describes the successful artery-only microvascular replantation of a large composite facial avulsion from a dog bite in a 24-month-old child, performed because no recipient vein could be identified from the facial defect. Medicinal leech therapy was used for eight days postoperatively to prevent venous congestion, resulting in significant blood loss that required nearly 29 L of blood product replacement. At 8 months follow-up, the patient was recovering well with significant improvement in function and cosmesis. The report relates to ASH's domain by documenting leech therapy as a component of postoperative care in pediatric microsurgery. A notable caveat is that this single case report highlights a massive transfusion requirement directly associated with prolonged leech therapy, and provides no broader statistical evidence on efficacy or safety.

Citation

Microvascular replantation of a composite facial avulsion in a 24-month-old child after dog bite.

Macias D et al. · Microsurgery, 2017

DOI

Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026

This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.