Total Nose and Upper Lip Replantation: A Case Report and Literature Review
Summary:. The nose plays a critical role in olfaction, air filtration and humidification, and facial aesthetics. Most nasal amputations result from animal bites, human bites, and lacerations from glass. Successful replantation yields the best aesthetic and functional outcomes and is preferred compar...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2018-10-01
|
| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001839 |
| _version_ | 1818027375567306752 |
|---|---|
| author | Kate Elzinga, MD, FRCSC Abelardo Medina, MD, PhD Regan Guilfoyle, MD, FRCSC |
| author_facet | Kate Elzinga, MD, FRCSC Abelardo Medina, MD, PhD Regan Guilfoyle, MD, FRCSC |
| author_sort | Kate Elzinga, MD, FRCSC |
| collection | DOAJ |
| description | Summary:. The nose plays a critical role in olfaction, air filtration and humidification, and facial aesthetics. Most nasal amputations result from animal bites, human bites, and lacerations from glass. Successful replantation yields the best aesthetic and functional outcomes and is preferred compared with multistage nasal reconstruction. However, nasal replantation is technically challenging; establishing venous outflow can be particularly difficult. A 17-year-old male sustained a complete nose and upper lip amputation in a motor vehicle accident. The midface segment was emergently replanted. Two arteries (left dorsal nasal artery, left superior labial artery) and 1 vein (branch of the left supratrochlear artery) were anastomosed using microsurgical technique. A vein graft, systemic anticoagulation, and postoperative leeching were important adjuncts. Total operative time was 10 hours. Cold ischemia time was 2 hours and warm ischemia time was 1 hour. Two arteries were anastomosed to minimize the risk of ischemia of the nose and/or upper lip. Complete survival of the replanted segment was achieved. Eighteen months postoperatively, the patient has bilateral nasal patency, intact septal support, and an excellent aesthetic result. All efforts should be made to establish a venous anastomosis during nasal replantation to maximize functional and aesthetic outcomes. Partial necrosis is common following artery-only replantation, leading to tissue loss and contracture. |
| first_indexed | 2024-12-10T04:46:54Z |
| format | Article |
| id | doaj.art-a2b5d5f62449477184a1dad3b61c77a3 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-10T04:46:54Z |
| publishDate | 2018-10-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-a2b5d5f62449477184a1dad3b61c77a32022-12-22T02:01:43ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742018-10-01610e183910.1097/GOX.0000000000001839201810000-00031Total Nose and Upper Lip Replantation: A Case Report and Literature ReviewKate Elzinga, MD, FRCSC0Abelardo Medina, MD, PhD1Regan Guilfoyle, MD, FRCSC2From the Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada.From the Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada.From the Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada.Summary:. The nose plays a critical role in olfaction, air filtration and humidification, and facial aesthetics. Most nasal amputations result from animal bites, human bites, and lacerations from glass. Successful replantation yields the best aesthetic and functional outcomes and is preferred compared with multistage nasal reconstruction. However, nasal replantation is technically challenging; establishing venous outflow can be particularly difficult. A 17-year-old male sustained a complete nose and upper lip amputation in a motor vehicle accident. The midface segment was emergently replanted. Two arteries (left dorsal nasal artery, left superior labial artery) and 1 vein (branch of the left supratrochlear artery) were anastomosed using microsurgical technique. A vein graft, systemic anticoagulation, and postoperative leeching were important adjuncts. Total operative time was 10 hours. Cold ischemia time was 2 hours and warm ischemia time was 1 hour. Two arteries were anastomosed to minimize the risk of ischemia of the nose and/or upper lip. Complete survival of the replanted segment was achieved. Eighteen months postoperatively, the patient has bilateral nasal patency, intact septal support, and an excellent aesthetic result. All efforts should be made to establish a venous anastomosis during nasal replantation to maximize functional and aesthetic outcomes. Partial necrosis is common following artery-only replantation, leading to tissue loss and contracture.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001839 |
| spellingShingle | Kate Elzinga, MD, FRCSC Abelardo Medina, MD, PhD Regan Guilfoyle, MD, FRCSC Total Nose and Upper Lip Replantation: A Case Report and Literature Review Plastic and Reconstructive Surgery, Global Open |
| title | Total Nose and Upper Lip Replantation: A Case Report and Literature Review |
| title_full | Total Nose and Upper Lip Replantation: A Case Report and Literature Review |
| title_fullStr | Total Nose and Upper Lip Replantation: A Case Report and Literature Review |
| title_full_unstemmed | Total Nose and Upper Lip Replantation: A Case Report and Literature Review |
| title_short | Total Nose and Upper Lip Replantation: A Case Report and Literature Review |
| title_sort | total nose and upper lip replantation a case report and literature review |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000001839 |
| work_keys_str_mv | AT kateelzingamdfrcsc totalnoseandupperlipreplantationacasereportandliteraturereview AT abelardomedinamdphd totalnoseandupperlipreplantationacasereportandliteraturereview AT reganguilfoylemdfrcsc totalnoseandupperlipreplantationacasereportandliteraturereview |