Dogbite

Dogbites are common cause of visit in the ER. Pit-bulls like in this case are the most common aggressors. Antibiotic therapy its very important since this are contaminated wounds. This patient arrived at 11pm and was rushed to the ER, for debridement and wound cleaning, the facial artery was ligated (since it had active bleeding) and referred for future free-flap revascularization. At 8am the next day a Radial forearm free-flap was planed. During the procedure we noted the flap was a little bulky in the malar area so a unilateral bichectomy was done to help the contour. A mucosal graft was placed in the upper lip, and a split skin graft was placed in the radial donor area. The patient had a great evolution. The pictures are up to 3 weeks after surgery. This surgery was done by @drjuliopalacios, @dr_marm__ and @erikhv

The radial forearm flap is a very versatile flap and is at its best as a cutaneous flap. It is ideally suited where complex patterns and designs are required and it is a relatively easy flap to manipulate in a variety of different dimensions. It can be formed into a tube or a double tube or split into several skin paddles for complex facial reconstruction. The rich vascular network lends itself to prefabrication either using the local tissue or incorporating distant tissues such as mucosa as grafts.