title: Conservative management of large avulsions of the lip and local landmarks.
abstract: Large lip avulsion injuries that involve significant tissue loss to the lip vermilion and other local landmarks can often pose a surgical dilemma for the reconstructive surgeon. Immediate reconstruction of these injuries are frequently performed using local flaps and adjacent tissue transfer to close the defect, but these repairs frequently suffer from the unfortunate consequence of increased associated scarring and further permanent distortion of the local anatomy. We present 2 patients sustaining dog bite injuries associated with extensive traumatic tissue loss to the lip vermilion and other local landmarks. These patients were treated conservatively with excellent functional and cosmetic results. A single minor surgical revision of 1 patient's cupid's bow was performed 1 year after injury. In cases of significant traumatic avulsion involving the lip vermilion and the perioral composite soft tissue, even with injuries including delicate anatomic landmarks, healing by secondary intention can be instituted as the initial treatment of choice in younger patients, often providing optimal results.
authors.affiliation: Section of Plastic Surgery, Department of Surgery, University of Michigan Medical Center, Ann Arbor, USA.
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Rhee
authors.forename: Christopher
authors.initials: C
authors.lastname: Colville
authors.forename: Steven R
authors.initials: SR
authors.lastname: Buchman
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001733:Bites and Stings / Q000628:therapy*; D002648:Child; D002921:Cicatrix / Q000517:prevention & control; D003131:Combined Modality Therapy; D004285:Dogs; D004954:Esthetics; D005151:Facial Injuries / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008046:Lip / Q000293:injuries* / Q000601:surgery; D008297:Male; D019651:Plastic Surgery Procedures; D013473:Sunscreening Agents / Q000627:therapeutic use; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents; D013473:Sunscreening Agents