Microvascular replantation of a composite facial avulsion in a 24-month-old child after dog bite
Case report published in 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.
Resumen
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.
Por qué esto importa para la hirudoterapia
Este caso clínico describe la reimplantación microvascular con anastomosis sólo arterial, exitosa, de una gran avulsión facial compuesta por mordedura de perro en un niño de 24 meses, realizada porque no pudo identificarse ninguna vena receptora en el defecto facial. Se empleó terapia con sanguijuelas medicinales durante ocho días en el postoperatorio para prevenir la congestión venosa, lo que provocó una pérdida sanguínea significativa que requirió la reposición de casi 29 L de hemoderivados. En el seguimiento a 8 meses, el paciente se estaba recuperando bien, con mejoría significativa de la función y la estética. El caso se relaciona con el ámbito de ASH al documentar la terapia con sanguijuelas como un componente de los cuidados postoperatorios en microcirugía pediátrica. Una salvedad notable es que este caso clínico único pone de relieve un requerimiento masivo de transfusión directamente asociado con la terapia prolongada con sanguijuelas, y no aporta evidencia estadística más amplia sobre eficacia o seguridad.
Citación
Microvascular replantation of a composite facial avulsion in a 24-month-old child after dog bite.
Macias D et al. · Microsurgery, 2017
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026