Microvascular replantation of avulsed tissue after a dog bite of the face

Various authors have described successful microsurgical replantation of totally avulsed facial tissue. In a significant number of cases difficulties were experienced with the venous anastomoses and/or venous drainage of the tissue. Many different methods were used to overcome the problem. Despite these difficulties, good cosmetic and functional results were reported. These injuries are often caused by animal bites. Adequate wound care and the excellent local blood supply make immediate reconstruction after animal bites of the face a safe procedure. Other authors describing similar lesions and immediate repair have not reported the complication of wound infection. We report on a patient who suffered a dog bite with total avulsion of most of the left upper lip, cheek and left alar rim. Venous congestion was overcome by multiple needle punctures to drain blood from the outer surface of the flap and local of application of heparin. A good cosmetic result and the return of sensation and function of the orbicularis oris muscle were obtained.