Upper lip replantation

A 28 year old woman presented at an emergency department on a weekend night at a rural hospital following dog bites sustained to her lips. There were two bites, one that lacerated the lower lip that was still connected to the face by a small, lateral pedicle and one that amputated more than half of the upper lip. The defect crossed the philtrum medially and extended laterally to the nasolabial fold (Figure 1).

The amputate, measuring 4.5 × 3 cm, had been kept in a hypothermic state (Figure 2). Emergency replantation surgery was initiated.

The lip rapidly turned blue as a sign of venous congestion. A leech (Hirudo medicinalis) was applied to the lip in order to achieve venous drainage and it immediately regained adequate skin color and became less swollen (Figure 3). The lower lip was also sutured in three layers and was adequately vascularized through the right inferior labial artery during the whole procedure.

During first night, leeches were applied every 45 min, and thereafter, the interval was extended, guided by the color of the lip; day 2 every 90 min, day 3–5 every 2 h, day 6–10 every 3 h, day 11–12 every 4 h. On the 13th day, the lip did not need leech therapy and the patient could be discharged on day 14.

After discharge, the follow-up was uneventful. At one-year follow-up, the patient had good oral continence, good lip motion, no problems with articulation, but the sensitivity for heat/cold and pin prick was still poor (Figure 4).

Credit: Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden, Jonas Gustafsson, Mattias Lidén, ncbi