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.
Resumen
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.
Por qué esto importa para la hirudoterapia
Este reporte de caso describe un varón de 17 años que fue sometido a una reimplantación microquirúrgica urgente de nariz y labio superior completamente amputados tras un accidente de tráfico, con aplicación postoperatoria de sanguijuelas como coadyuvante a la anticoagulación sistémica y al injerto venoso. Los autores subrayan la dificultad de establecer el drenaje venoso en la reimplantación nasal y destacan la sanguijueloterapia como medida de apoyo para manejar la congestión venosa cuando la anastomosis venosa resulta problemática. Para el ámbito de ASH, esto ilustra un papel clínico reconocido de las sanguijuelas medicinales como coadyuvante en cirugía compleja de reimplantación donde el compromiso venoso amenaza la supervivencia tisular. La advertencia honesta es que se trata de un reporte de caso único, la sanguijueloterapia es solo uno de varios coadyuvantes descritos, y el resumen no aporta detalles sobre la especie de sanguijuela, la duración, el número aplicado ni las complicaciones, lo que limita cualquier inferencia sobre las especificidades de la terapia con sanguijuelas.
Citación
Total nose and upper lip replantation: a case report and literature review.
Elzinga K et al. · Plastic and reconstructive surgery. Global open, 2018
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026