Pedram Daraei1, Jason P Calligas2, Elizabeth Katz2, Joanna W Etra3, Anita B Sethna4. 1. Emory University School of Medicine, Atlanta, GA, USA. Electronic address: pdaraei@emory.edu. 2. Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA. 3. Emory University School of Medicine, Atlanta, GA, USA. 4. Emory Aesthetic Center, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Abstract
IMPORTANCE: Upper lip avulsion after traumatic dog bite is a serious cause of facial disfigurement for which there is no consensus on management in the acute setting. OBJECTIVE: This review was prompted by a case at our institution and is intended to display the available evidence in the management of the patient after dog bite injury to the upper lip. Our main goals are to create a management algorithm using current evidence and to stimulate further clinical investigation to improve outcomes in patients with facial dog bite injuries. EVIDENCE REVIEW: A review of English literature was performed using Pubmed/MEDLINE for case reports and case series of lip replantation using microvascular anastomosis. Additional review of hyperbaric oxygen therapy, medicinal leech therapy, lip reconstruction methods, and reapproximation was performed. Reference searches were performed for all retrieved articles. FINDINGS: Microvascular replantation is a successful method of acute management in dog bite injuries of the lip. Hyperbaric oxygen therapy and medicinal leech therapy improve outcomes. Immediate cross-lip flaps and immediate reapproximation are alternative techniques that can be performed in the acute setting, but further investigation is required. CONCLUSIONS: The repair of the upper lip after a dog bite is a priority due to the functional and psychiatric sequelae associated with facial disfigurement. Microvascular replantation should be considered first-line. Immediate reapproximation without microvascular reanastomosis and immediate reconstruction may also be performed. A stepwise clinical algorithm may aid the surgeon in the acute management of dog bite trauma to the lip.
IMPORTANCE: Upper lip avulsion after traumatic dog bite is a serious cause of facial disfigurement for which there is no consensus on management in the acute setting. OBJECTIVE: This review was prompted by a case at our institution and is intended to display the available evidence in the management of the patient after dogbite injury to the upper lip. Our main goals are to create a management algorithm using current evidence and to stimulate further clinical investigation to improve outcomes in patients with facial dog bite injuries. EVIDENCE REVIEW: A review of English literature was performed using Pubmed/MEDLINE for case reports and case series of lip replantation using microvascular anastomosis. Additional review of hyperbaric oxygen therapy, medicinal leech therapy, lip reconstruction methods, and reapproximation was performed. Reference searches were performed for all retrieved articles. FINDINGS: Microvascular replantation is a successful method of acute management in dog bite injuries of the lip. Hyperbaric oxygen therapy and medicinal leech therapy improve outcomes. Immediate cross-lip flaps and immediate reapproximation are alternative techniques that can be performed in the acute setting, but further investigation is required. CONCLUSIONS: The repair of the upper lip after a dog bite is a priority due to the functional and psychiatric sequelae associated with facial disfigurement. Microvascular replantation should be considered first-line. Immediate reapproximation without microvascular reanastomosis and immediate reconstruction may also be performed. A stepwise clinical algorithm may aid the surgeon in the acute management of dog bite trauma to the lip.