Upper Lip Amputation: Microsurgical Replantation and Postoperative Routine

Abstract

Lip amputations are rare and usually the result of animal bites (dog, human), accidents, or sharp trauma (knife attack). The case presented is a young woman who was attacked by a dog and suffered an amputation of more than half of her upper lip, as well as a partial lower lip avulsion.

The amputated lip was kept cool, and the patient was immediately taken to operating theatre for replantation. The upper labial artery was identified both in the amputated segment and in the recipient area. Microvascular anastomosis was performed and the segment was reperfused. No vein suitable for venous anastomosis was found; hence, leech therapy was initiated to relieve the venous congestion.

The arterial anastomosis remained patent and leeching continued for 11 days. The recovery was uneventful and no further revision was required.

The lips have unique anatomic properties which are impossible to reconstruct in full when a larger segment is lost. Thus, replantation is pivotal in order to maintain oral functions and aesthetic appearance. Arterial anastomosis is usually feasible using the labial artery. However, veins large enough for anastomosis are seldom found, and even in cases where venous anastomosis can be performed, venous congestion is common. Hence, it is important to be prepared to use additional methods for relief of this congestion.