Andrew H Huang1, Michael S Wong. 1. From the Division of Plastic Surgery, University of California Davis Medical Center, Sacramento, CA.
Abstract
PURPOSE: This study aimed to describe immediate nasal reconstruction using a forehead flap after dog bite injuries. BACKGROUND: Dog bites to the nose can avulse multiple aesthetic subunits, making primary repair difficult, inadvisable, or impossible. Microsurgical replantation and composite grafting of the nose have been reported, but this assumes the avulsed nasal segments are salvageable even after the animal's attack. METHODS: We present 2 cases of dog bites to the nose with loss of multiple aesthetic subunits. The avulsed portions of the nose were not recovered. A search of the literature (OVID MEDLINE) was also performed, reviewing acute reconstruction of nasal defects after animal bites. RESULTS: Acute forehead flaps were used as part of a first-stage operation to reconstruct the nasal defects. Second- and third-stage operations were performed to thin and divide the flap, respectively. Although the defects involved the full thickness of the nose, only the skin and nasal lining were acutely reconstructed. Acute cartilage grafts were not used due to concern of wound contamination; however, some resultant collapse of the nasal vestibule was noted and selectively addressed with subsequent cartilage grafting. DISCUSSION: Dog bites to the face can create immediately disfiguring injuries that may initially seem devastating. Nonetheless, soft tissue damage often can be primarily repaired, leading to roughly linear scars that can be revised later. However, nasal injuries from dog bites can be more challenging if multiple subunits are irreparably lost. Acute forehead flap reconstruction after dog bite-concomitant with initial debridement-is a reliable method of reconstruction. It remains to be seen whether acute cartilage grafts would be useful during the first-stage reconstructive operation for better long-term outcomes.
PURPOSE: This study aimed to describe immediate nasal reconstruction using a forehead flap after dog bite injuries. BACKGROUND:Dog bites to the nose can avulse multiple aesthetic subunits, making primary repair difficult, inadvisable, or impossible. Microsurgical replantation and composite grafting of the nose have been reported, but this assumes the avulsed nasal segments are salvageable even after the animal's attack. METHODS: We present 2 cases of dog bites to the nose with loss of multiple aesthetic subunits. The avulsed portions of the nose were not recovered. A search of the literature (OVID MEDLINE) was also performed, reviewing acute reconstruction of nasal defects after animal bites. RESULTS: Acute forehead flaps were used as part of a first-stage operation to reconstruct the nasal defects. Second- and third-stage operations were performed to thin and divide the flap, respectively. Although the defects involved the full thickness of the nose, only the skin and nasal lining were acutely reconstructed. Acute cartilage grafts were not used due to concern of wound contamination; however, some resultant collapse of the nasal vestibule was noted and selectively addressed with subsequent cartilage grafting. DISCUSSION: Dog bites to the face can create immediately disfiguring injuries that may initially seem devastating. Nonetheless, soft tissue damage often can be primarily repaired, leading to roughly linear scars that can be revised later. However, nasal injuries from dog bites can be more challenging if multiple subunits are irreparably lost. Acute forehead flap reconstruction after dog bite-concomitant with initial debridement-is a reliable method of reconstruction. It remains to be seen whether acute cartilage grafts would be useful during the first-stage reconstructive operation for better long-term outcomes.