A 28-year-old woman presented to a local rural hospital on a weekend night following dog bites sustained to her lips.
A 28-year old woman from a rural area presented to the emergency department after she had been bit by a dog on her lips. Physical examination revealed two bites, with laceration of the lower lip, which was still connected to the face by a small lateral pedicle. Whereas, more than half of the upper lip was amputated. The defect medially crossed the philtrum and extended to the nasolabial fold laterally.
The amputate measured 4.5 x 3 cm and was kept in a hypothermic state and emergency replantation surgery was initiated.
However, venous congestion caused the lip to turn blue. A In order to achieve venous drainage, a leech (Hirudo medicinalis) was applied to the lip. The skin immediately gained adequate skin colour and became less swollen. The lower lip was also adequately vascualrised through the inferior labial artery throughout the procedure and the lower lip was sutured in three layers.
For the first night, the leech was applied every 45 minutes and the interval was extended depending on the colour of the lip. The time duration was increased by 90 minutes on the 2nd day, every 2 hours from days 3 to 5, every 3 hours from days 6 to 10 and every 4 hours from days 11 to 12. On the 13th day, the lop did not require any leech therapy and the patient was discharged on the 14th day after admission.
However, the follow-up was quite uneventful after the patient was discharged. She showed poor sensitivity to heat/cold and pin prick. Although, the patient did not complain of any problems with articulation, had good lip motion and good oral continence at one-year-follow up.
References
Gustafsson, J., Lidén, M., & Thorarinsson, A. (2016). Microsurgically aided upper lip replantation–case report and literature review. Case Reports in Plastic Surgery and Hand Surgery, 3(1), 66-69.
