Total nose and upper lip replantation: a case report and literature review
Case report published in Plast Reconstr Surg Glob Open (2018)
Abstract
The nose plays a critical role in olfaction, air filtration and humidification, and facial aesthetics. Most nasal amputations result from animal bites, human bites, and lacerations from glass. Successful replantation yields the best aesthetic and functional outcomes and is preferred compared with multistage nasal reconstruction. However, nasal replantation is technically challenging; establishing venous outflow can be particularly difficult. A 17-year-old male sustained a complete nose and upper lip amputation in a motor vehicle accident. The midface segment was emergently replanted. Two arteries (left dorsal nasal artery, left superior labial artery) and 1 vein (branch of the left supratrochlear artery) were anastomosed using microsurgical technique. A vein graft, systemic anticoagulation, and postoperative leeching were important adjuncts. Total operative time was 10 hours. Cold ischemia time was 2 hours and warm ischemia time was 1 hour. Two arteries were anastomosed to minimize the risk of ischemia of the nose and/or upper lip. Complete survival of the replanted segment was achieved. Eighteen months postoperatively, the patient has bilateral nasal patency, intact septal support, and an excellent aesthetic result. All efforts should be made to establish a venous anastomosis during nasal replantation to maximize functional and aesthetic outcomes. Partial necrosis is common following artery-only replantation, leading to tissue loss and contracture.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
17-year-old male with complete nose-and-upper-lip amputation underwent emergent microsurgical replantation. Two arterial anastomoses + one vein, with postoperative leeching and systemic anticoagulation. Complete segment survival.
Why This Matters for Hirudotherapy
This case report describes a 17-year-old male who underwent emergent microsurgical replantation of a completely amputated nose and upper lip after a motor vehicle accident, with postoperative leeching used as an adjunct to systemic anticoagulation and venous grafting. The authors emphasize the difficulty of establishing venous outflow in nasal replantation and highlight leeching as a supportive measure to manage venous congestion when venous anastomosis is challenging. For ASH's domain, this illustrates a recognized clinical role for medicinal leeches as an adjunct in complex replantation surgery where venous compromise threatens tissue survival. The honest caveat is that this is a single case report, leeching is only one of several adjuncts described, and the abstract provides no details on leech species, duration, number applied, or complications, limiting any inference about leech therapy specifics.
Citation
Total nose and upper lip replantation: a case report and literature review.
Elzinga K et al. · Plastic and reconstructive surgery. Global open, 2018
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