title: Reconstruction of upper lip avulsion after dog bite: case report and review of literature.
abstract: OBJECTIVE
  Upper lip avulsion after traumatic dog bite is a serious cause of facial disfigurement for which there is no consensus on management in the acute setting.
  
  
  OBJECTIVE
  This review was prompted by a case at our institution and is intended to display the available evidence in the management of the patient after dog bite injury to the upper lip. Our main goals are to create a management algorithm using current evidence and to stimulate further clinical investigation to improve outcomes in patients with facial dog bite injuries.
  
  
  METHODS
  A review of English literature was performed using Pubmed/MEDLINE for case reports and case series of lip replantation using microvascular anastomosis. Additional review of hyperbaric oxygen therapy, medicinal leech therapy, lip reconstruction methods, and reapproximation was performed. Reference searches were performed for all retrieved articles.
  
  
  RESULTS
  Microvascular replantation is a successful method of acute management in dog bite injuries of the lip. Hyperbaric oxygen therapy and medicinal leech therapy improve outcomes. Immediate cross-lip flaps and immediate reapproximation are alternative techniques that can be performed in the acute setting, but further investigation is required.
  
  
  CONCLUSIONS
  The repair of the upper lip after a dog bite is a priority due to the functional and psychiatric sequelae associated with facial disfigurement. Microvascular replantation should be considered first-line. Immediate reapproximation without microvascular reanastomosis and immediate reconstruction may also be performed. A stepwise clinical algorithm may aid the surgeon in the acute management of dog bite trauma to the lip.
authors: Emory University School of Medicine, Atlanta, GA, USA. Electronic address: pdaraei@emory.edu.
authors: Pedram
authors: P
authors: Daraei
authors: Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors: Jason P
authors: JP
authors: Calligas
authors: Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors: Elizabeth
authors: E
authors: Katz
authors: Emory University School of Medicine, Atlanta, GA, USA.
authors: Joanna W
authors: JW
authors: Etra
authors: Emory Aesthetic Center, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors: Anita B
authors: AB
authors: Sethna
mesh_terms: D000328:Adult; D000818:Animals; D001733:Bites and Stings / Q000601:surgery*; D004285:Dogs; D005151:Facial Injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D008046:Lip / Q000293:injuries / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D009061:Mouth Mucosa / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D014945:Wound Healing