1
|
Galmard L, Mari R, Noyelles L, Bettega G, Bouchet B, Escudier E, Tolsma V, Lartizien R. Replantation of a lip thrown in the bin. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:81-84. [PMID: 33429064 DOI: 10.1016/j.jormas.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
Management of soft tissue avulsion after facial bites could be challenging in some situation. We presented the case of a 32 years old men suffering from a full thickness avulsion of the left lower lip and cheek after a dog bite. Even if the lip fragment was initially put on the bin, a microvascular replantation was performed. The vascularization was based on the left inferior labial artery. No veins were found. We used post-operative leech therapy to avoid venous congestion during 10 days. A large antibiotherapy was conducted. Adaptation of antibiotics blood concentration was also necessary due to the permanent bleeding caused by leech therapy. At the 6 month consultation, the patient recovered an impressive labial function and sensibility. Replantation gives the best functional and esthetical outcomes in these rare and complex cases. Artificial blood drainage, large antibiotic therapy and close post-operative follow-up are significant parts of the replantation success.
Collapse
Affiliation(s)
- L Galmard
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier d'Annecy Genevois, Annecy France; Faculté de Médecine, Université Grenoble Alpes, Grenoble France
| | - R Mari
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier d'Annecy Genevois, Annecy France; Faculté de Médecine, Université Grenoble Alpes, Grenoble France
| | - L Noyelles
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier d'Annecy Genevois, Annecy France
| | - G Bettega
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier d'Annecy Genevois, Annecy France
| | - B Bouchet
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier d'Annecy Genevois, Annecy France
| | - E Escudier
- Service de Réanimation, Centre Hospitalier d'Annecy Genevois, Annecy France
| | - V Tolsma
- Service de Maladies Infectieuses, Centre Hospitalier d'Annecy Genevois, Annecy France
| | - R Lartizien
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier d'Annecy Genevois, Annecy France; Faculté de Médecine, Université Grenoble Alpes, Grenoble France.
| |
Collapse
|
2
|
Abstract
Traumatic facial soft tissue injury often creates both aesthetic and functional deficits. In complete lip avulsions, microvascular replantation is a reconstructive option that has the potential to fulfill both of these goals. However, lip replantations remain rare and there are few reports in the literature. The authors aim to present a clinical report of a young male who sustained a human bite injury and underwent microvascular replantation of a completely avulsed lower lip and to review the literature and management of these complex injuries.
Collapse
|
3
|
Tachi K, Mori M, Tsukuura R, Hirai R. Successful microsurgical lip replantation: Monitoring venous congestion by blood glucose measurements in the replanted lip. JPRAS Open 2017; 15:51-55. [PMID: 32158798 PMCID: PMC7061677 DOI: 10.1016/j.jpra.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/20/2017] [Indexed: 11/23/2022] Open
Abstract
Replantation of an amputated lip using microvascular anastomosis is the best option for restoration of the defect. However, the amputated region often lacks veins with appropriate diameters for microvascular anastomoses and typically necessitates both postoperative exsanguination using medicinal leeches and a blood transfusion. We present a case of the successful replantation of an avulsed lip in which postoperative congestion was evaluated objectively by measuring blood glucose levels in the replanted region. The patient presented to our hospital with an upper lip avulsion that was caused by a dog bite. The lip was replanted by the microvascular anastomoses of one artery and two veins using interposed vein grafts. The replanted lip showed signs of congestion on postoperative day one; exsanguination using medicinal leeches was attempted, while blood glucose levels were measured every three hours. Critical congestion, which did not occur in this patient, was defined as a blood glucose level lower than 40 mg/dL. Lip replantation was successful without any complications in this patient.
Collapse
Affiliation(s)
- Kazufumi Tachi
- Plastic and Reconstructive Surgery, Asahi General Hospital, I-1326, Asahi-Shi, Chiba-Ken, 289-2511, Japan
| | - Masanori Mori
- Plastic and Reconstructive Surgery, Asahi General Hospital, I-1326, Asahi-Shi, Chiba-Ken, 289-2511, Japan
| | - Reiko Tsukuura
- Plastic and Reconstructive Surgery, Asahi General Hospital, I-1326, Asahi-Shi, Chiba-Ken, 289-2511, Japan
| | - Rintaro Hirai
- Plastic and Reconstructive Surgery, Asahi General Hospital, I-1326, Asahi-Shi, Chiba-Ken, 289-2511, Japan
| |
Collapse
|
4
|
Abstract
The management of soft tissue injury after facial trauma poses unique challenges to the plastic surgeon, given the specialized nature of facial tissue and the aesthetic importance of the face. The general principles of trauma management and wound care are applied in all cases. The management of severe injuries to the face is discussed in relation to the location and the mechanism of injury. Facial transplants have arisen in the past decade for the management of catastrophic soft tissue defects, although high morbidity and mortality after these non-life-saving operations must be considered in patient selection.
Collapse
Affiliation(s)
- Tara L Braun
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Renata S Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
5
|
Gustafsson J, Lidén M, Thorarinsson A. Microsurgically aided upper lip replantation - case report and literature review. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2016; 3:66-69. [PMID: 27713916 PMCID: PMC5051554 DOI: 10.1080/23320885.2016.1226141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/13/2016] [Indexed: 12/04/2022]
Abstract
A case with a patient who suffered an upper lip amputation and a lower lip laceration due to dog bite is presented. The amputated segment was replanted using microsurgical technique. The operative technique and postoperative care is presented, as well as a review of the current literature on the subject.
Collapse
Affiliation(s)
- Jonas Gustafsson
- Department of Plastic Surgery, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Mattias Lidén
- Department of Plastic Surgery, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Andri Thorarinsson
- Department of Plastic Surgery, Sahlgrenska University Hospital , Gothenburg , Sweden
| |
Collapse
|
6
|
Daraei P, Calligas JP, Katz E, Etra JW, Sethna AB. Reconstruction of upper lip avulsion after dog bite: case report and review of literature. Am J Otolaryngol 2014; 35:219-25. [PMID: 24332929 DOI: 10.1016/j.amjoto.2013.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/12/2013] [Indexed: 11/17/2022]
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.
Collapse
Affiliation(s)
- Pedram Daraei
- Emory University School of Medicine, Atlanta, GA, USA.
| | - Jason P Calligas
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth Katz
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Joanna W Etra
- Emory University School of Medicine, Atlanta, GA, USA
| | - Anita B Sethna
- Emory Aesthetic Center, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
7
|
|
8
|
Whitaker IS, Oboumarzouk O, Rozen WM, Naderi N, Balasubramanian SP, Azzopardi EA, Kon M. The efficacy of medicinal leeches in plastic and reconstructive surgery: a systematic review of 277 reported clinical cases. Microsurgery 2012; 32:240-50. [PMID: 22407551 DOI: 10.1002/micr.20971] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 09/21/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although there are numerous case reports and small case series describing the experiences of leech therapy in various circumstances, there are relatively few large studies evaluating the effectiveness of leeching to relieve venous congestion. The therapeutic value of leeching is illustrated by these reports but the current literature lacks a cohesive summary of previous experiences. METHODS An electronic search of PubMed, the Cochrane library and the Centre for Reviews and Dissemination between 1966 and 2009 was used to retrieve human studies published in the English language evaluating outcomes following leech therapy. The "success" and "failure" of leech therapy were the primary outcome measures and secondary outcomes included complications, number of leeches used, pharmacological adjuncts and blood transfusion requirements. RESULTS In total, out of 461 articles, 394 articles met the exclusion criteria. The 67 included papers reported on 277 cases of leech use with an age range of 2-81 years and a male to female ratio of almost 2:1. The overall reported "success" rate following leech therapy was 77.98% (216/277). In terms of secondary outcome measures, 49.75% of cases (N = 101) required blood transfusions, 79.05% received antibiotics (N = 166) and 54.29% received concomitant anticoagulant therapy. The overall complication rate was 21.8%. CONCLUSION In the absence of robust randomized controlled trials on which the evidence may be based, this synthesis of current best evidence guides clinicians during the process of consenting patients and using leeches in their practice.
Collapse
Affiliation(s)
- Iain S Whitaker
- Department of Burns and Plastic Surgery, Morriston Hospital, Swansea, Wales, UK.
| | | | | | | | | | | | | |
Collapse
|
9
|
Taylor HOB, Andrews B. Lip replantation and delayed inset after a dog bite: A case report and literature review. Microsurgery 2009; 29:657-61. [DOI: 10.1002/micr.20653] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
10
|
Whitaker IS, Cheung CK, Chahal CAA, Karoo ROS, Gulati A, Foo ITH. By what mechanism do leeches help to salvage ischaemic tissues? A review. Br J Oral Maxillofac Surg 2005; 43:155-60. [PMID: 15749217 DOI: 10.1016/j.bjoms.2004.09.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2004] [Indexed: 11/19/2022]
Abstract
The therapeutic use of leeches in medicine dates back to 50 b.c. and was cited by ancient authors. The medicinal leech, Hirudo medicinalis, has been used with increasing frequency during the past few years by reconstructive surgeons to help salvage ischaemic tissues. We aim to summarise the anatomy, physiology, and pharmacological mechanisms of action of leeches to provide reconstructive surgeons with a theoretical basis for their use.
Collapse
Affiliation(s)
- I S Whitaker
- Department of Otolaryngology and Head and Neck Surgery, Leeds General Infirmary, Leeds, UK.
| | | | | | | | | | | |
Collapse
|
11
|
Whitaker IS, Izadi D, Oliver DW, Monteath G, Butler PE. Hirudo Medicinalis and the plastic surgeon. ACTA ACUST UNITED AC 2004; 57:348-53. [PMID: 15145739 DOI: 10.1016/j.bjps.2003.12.016] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2003] [Accepted: 12/16/2003] [Indexed: 11/30/2022]
Abstract
Medicinal leech therapy is an ancient craft that dates back to ancient Egypt and the beginnings of civilisation. The popularity of Hirudo Medicinalis has varied throughout history, reaching such a peak in Europe in the early 19th century that supplies were exhausted. During the latter half of the 19th century, their use fell out of favour, as they did not fit in with the emerging concepts of modern medicine. Leeches have enjoyed a renaissance in the world of reconstructive microsurgery during recent years, and their first reported use in alleviating venous engorgement following flap surgery was reported in this journal [M Derganc, F Zdravic, Venous congestion of flaps treated by application of leeches, Br J Plast Surg 13 (1960) 187]. Contemporary plastic and reconstructive surgeons in units throughout the United Kingdom and Ireland continue to use leeches to aid salvage of failing flaps. We carried out a survey of all 62 plastic surgery units in the United Kingdom and the Republic of Ireland to assess the current extent of use, and to investigate current practice. We have shown that the majority of plastic surgery units in the UK and Ireland use leeches post-operatively and that the average number of patients requiring leech therapy was 10 cases per unit per year. Almost all units use antibiotic prophylaxis, but the type of antibiotic and combination used is variable. We outline current practice and suggest a protocol for the use of leeches. Whilst the use of leeches is widespread, the plastic surgery community has progressed little in defining indications for their use or in achieving an accepted protocol for their application in units throughout the UK and Ireland.
Collapse
Affiliation(s)
- I S Whitaker
- Department of Anatomy, University of Cambridge, Downing Street, Cambridge CB2 3DY, UK.
| | | | | | | | | |
Collapse
|
12
|
Whitaker IS, Rao J, Izadi D, Butler PE. Historical Article: Hirudo medicinalis : ancient origins of, and trends in the use of medicinal leeches throughout history. Br J Oral Maxillofac Surg 2004; 42:133-7. [PMID: 15013545 DOI: 10.1016/s0266-4356(03)00242-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2003] [Indexed: 11/17/2022]
Abstract
Blood letting and the therapeutic use of Hirudo medicinalis date back to ancient Egypt and the beginning of civilisation. Their popularity has varied over the years, reaching such a peak in Europe between 1825 and 1850 that supplies were exhausted. Towards the end of the century they fell out of favour and, during this period, the leech, once used by the physicians of emperors and influential academic surgeons, became associated with lay therapists and quackery. Leeches have enjoyed a renaissance in reconstructive microsurgery during the last 15 years, having been used by maxillofacial [Br. J. Oral Maxillofac. Surg 41 (2003) 44] and other reconstructive surgeons to aid salvage of compromised microvascular free tissue transfers [Laryngoscope 108 (1998) 1129; Br. J. Plast. Surg. 34 (1984) 358], replanted digits [Int. J. Microsurg. 3 (1981) 265], ears [Ann. Plast. Surg. 43 (1999) 427], lips [Plast. Reconstr. Surg. 102 (1998) 358; J. Reconstr. Microsurg. 9 (1993) 327] and nasal tips [Br. J. Oral Maxillofac. Surg. 36 (1998) 462]. Peer-reviewed evidence suggests that the survival of compromised, venous-congested tissues is improved by early application of a leech [J. Reconstr. Microsurg. 12 (1996) 165; Arch. Otolaryngol. Head Neck Surg. 114 (1988) 1395; Br. J. Plast. Surg. 45 (1992) 235]. Leeches have also recently been used to treat a wide range of conditions, including periorbital haematomas [Br. J. Ophthalmol. 75 (1991) 755], severe macroglossia [Otolaryngol. Head Neck Surg. 125 (2001) 649; J. Laryngol. Otol. 109 (1995) 442] and purpura fulminans [Ann. Plast. Surg. 35 (1995) 300]. The first medicinal leech farm, Biopharm, was set up in Swansea in 1981 by Dr Roy Sawyer, and now supplies leeches to hospitals all over the world. In this paper, we summarise the history of treatment with Hirudo medicinalis from its origin to the present day, and take a brief look at the possible future of the annelid.
Collapse
Affiliation(s)
- I S Whitaker
- Department of Anatomy, University of Cambridge, Cambridge, UK.
| | | | | | | |
Collapse
|
13
|
Duroure F, Simon E, Fadhul S, Fyad JP, Chassagne JF, Stricker M. Microsurgical lip replantation: Evaluation of functional and aesthetic results of three cases. Microsurgery 2004; 24:265-9. [PMID: 15274181 DOI: 10.1002/micr.20018] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Lip amputations are rare, and microsurgical replantation must be systematically tried to restore form and function in one step. The authors present a series of three cases. Revascularization of the amputated segment was obtained by arterial anastomosis with the corresponding labial coronary artery. No venous anastomosis was carried out, because no vein could be identified. Venous drainage was obtained by inducing bleeding and by postoperative application of leeches for 6 days. Anticoagulant therapy and antibiotherapy were used for 10 days. With this approach, two lip amputations were completely saved, and a third amputation only suffered partial necrosis. Aesthetic and functional results were evaluated as being good, with reestablishment of labial continence and recovery of protective sensitivity.
Collapse
Affiliation(s)
- F Duroure
- Department of Maxillofacial and Plastic Surgery, Centre Hospitalo Universitaire, Nancy, France.
| | | | | | | | | | | |
Collapse
|
14
|
|
15
|
Stricker M, Simon E, Duroure F. [Full thickness defects of the lips. Reconstructive techniques and indications]. ANN CHIR PLAST ESTH 2002; 47:449-78. [PMID: 12449872 DOI: 10.1016/s0294-1260(02)00146-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The full-thickness tissue loss of the lip leads to the loss of lip continuity. The classic principle is to repair a lip with a lip, giving the best results. Although the size of tissue lost can force to use local flaps, these could be naso-labio-jugal, labio-mental or submental. Even though the microsurgical labial replantation is the technique of choice, unfortunately, most of the time it cannot be done as a result of the situation and the conservation of the avulsed fragment.
Collapse
Affiliation(s)
- M Stricker
- Service de chirurgie maxillo-faciale et plastique de la face, CHU Nancy, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | | | | |
Collapse
|
16
|
Walton RL, Beahm EK, Brown RE, Upton J, Reinke K, Fudem G, Banis J, Davidson J, Dabb R, Kalimuthu R, Kitzmiller WJ, Gottlieb LJ, Buncke HJ. Microsurgical replantation of the lip: a multi-institutional experience. Plast Reconstr Surg 1998; 102:358-68. [PMID: 9703070 DOI: 10.1097/00006534-199808000-00009] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Traumatic amputation of the lip is a rare yet devastating event affecting both form and function. Considering the available methods for reconstruction, replantation may offer a reasonable solution. We sought to characterize the variables associated with lip replantation and to assess the outcome in a retrospective review of 13 lip replantations performed in 12 institutions utilizing a form database and clinical and photographic analysis. Lip replantation was successful in all 13 patients; partial flap loss occurred in one patient owing to iatrogenic injury. Follow-up averaged 3.1 years. Average patient age at the time of injury was 21.1 years. There were six male and seven female patients. Injuries in two patients were the result of a human bite, the remaining injuries resulted from dog bites. One patient had significant associated injuries. Average length of hospital stay was 11.9 days. Ten patients suffered amputations of the upper lip, and three suffered amputations of the lower lip. Average defect size was 10.6 cm2. Operative time averaged 5.7 hours (range 2.5 to 12 hours). Warm ischemia time averaged 2.9 hours, and cold ischemia time averaged 2.7 hours. Donor and recipient veins were often scarce; all patients had at least one arterial anastomosis, whereas no vein was available in 7 of 13 patients; vein grafts were required in one patient. Leech therapy was employed in 11 of 13 patients. Anticoagulant therapy was administered in the majority of patients. Systemic heparin was utilized in 10 of 13 patients, low molecular weight dextran was used in 7 of 13 patients, and aspirin was given to 7 of 13 patients. One bleeding complication was incurred. An average of 6.2 units of packed red blood cells was administered to 12 of 13 patients (adjusted to 250 cc/unit). Antispasmodic therapy was employed in six of eight patients intraoperatively and in two of eight patients postoperatively. Intraoperative complications included difficulty identifying veins in 7 of 13 patients, arterial spasm in 1 of 13 patients, and vessel diameter < 0.5 mm in 4 patients. Postoperatively, one patient suffered vein thrombosis requiring anastomotic revision. Broad spectrum antibiotics were administered to all patients, and there were no infections. Nearly one-third (4 of 13) patients suffered prolonged edema lasting > 4 months. Color match of the replanted lip segment was rated excellent in all cases. Hypertrophic scarring occurred in 6 of 13 patients. A total of 12 revision procedures was performed in six patients. Interestingly, leech therapy resulted in permanent visible scarring as a result of the leech bite in 6 of 11 patients treated. Ten patients demonstrated active orbicularis muscle contraction in the replanted lip segment. Stomal continence was present in all lips. Sensibility return in the replanted lip segment was quite good with 12 of 13 patients demonstrating at least protective moving two-point sensibility (> or = 10 mm). Partial replant necrosis in one patient resulted in significant scar and contraction that compromised the aesthetic appearance. Overall, however, all patients were uniformly pleased with their final results. This clinical study is one of the largest of its kind on lip replantation. Although this represents a multi-institutional experience, the data are remarkably consistent. Re-establishment of venous outflow seems to be the most problematic technical challenge. By incorporating the adjuncts of anticoagulation, leech therapy, and antispasmodics, a successful outcome can be expected despite the paucity of vessels and small vessel size. The risks of blood transfusion, lengthy operative time, and hospital stay must be weighed against the functional benefits.
Collapse
Affiliation(s)
- R L Walton
- Section of Plastic Surgery, University of Chicago Hospitals, Ill, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Tanaka Y, Tajima S, Byen M, Byen K, Terao K, Chikamori M. Replantation of a large amputated segment of the face: a new technique. Microsurgery 1995; 16:594-7. [PMID: 8747281 DOI: 10.1002/micr.1920160903] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Y Tanaka
- Department of Plastic and Reconstructive Surgery, Osaka Medical College, Japan
| | | | | | | | | | | |
Collapse
|