Microsurgical replantation and postoperative leech treatment of a large severed nasal segment

Microsurgical Replantation of Completely Avulsed Nasal Segment

Complete avulsion of the nose is a devastating injury that may result in permanent disfigurement. Microvascular reattachment is technically difficult due to small size of the injured vessels, associated avulsion or crush injury, and relative inability to achieve venous anastomosis. This report describes a successful case of microsurgical replantation of the distal third of the nose in a 47-year-old patient after a dog bite injury with the use of a superficial temporal vein graft for arterial repair and leeching for venous outflow. The recovery was uneventful with total survival of the replant noted except for marginal skin necrosis, which healed by secondary intention. There was no need for any transfusion. The authors found that use of the superficial temporal vein for arterial revascularization was efficient and convenient as it was in the same surgical field, offering a favorable donor site scar in the preauricular sulcus. Microsurgical replantation should be attempted whenever feasible in cases of complete nose amputation.

Total Nose and Upper Lip Replantation: A Case Report and Literature Review

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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.

Long-term outcomes of microsurgical nasal replantation: review of the literature and illustrated 10-year follow-up of a pediatric case with full sensory recovery

We present a case of successful artery only total nose replantation in an 18-month-old child, with 10 years of follow-up and full sensory recovery despite no nerve repair. The common absence of veins for anastomosis does not prevent successful replant, as demonstrated with the use of Hirudo medicinalis use in this unique case. We comprehensively review the literature of this rare and complex injury and advocate microsurgical replantation where possible over other methods of nasal reconstruction.