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
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.
Citación
Microvascular replantation of a composite facial avulsion in a 24-month-old child after dog bite.
Macias D et al. · Microsurgery, 2017
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: June 18, 2026