Normobaric and Hyperbaric Oxygen Therapy in Pediatric Dog Bite Nasal Tip Avulsion/Replantation

A 4-year-old healthy girl sustained a composite dog bite avulsion of the tip of her nose that was intraoperatively replanted without vascular reanastomosis 2 hours and 45 minutes after the avulsion. The replanted tip initially appeared viable, but became dusky at 16 hours and cyanotic at 32 hours postreplantation. Hyperbaric oxygen therapy commenced at 40 hours postreplantation, and intermittent normobaric oxygen was added at night after the fourth hyperbaric oxygen treatment. Hyperbaric oxygen therapy was dosed according to tissue response/appearance and signs of patient oxidative stress with progressive improvement in viability. The patient received 30 hyperbaric oxygen treatments in 26 days and normobaric oxygen from postoperative day 3 to 13 days after the last hyperbaric oxygen treatment. The replantation achieved 100% survival and an excellent cosmetic result.