Case 1 – Dog bite to the lip
By Magnus Balslev Avnstorp, MD
Introduction
25-year-old female with a traumatic dog bite to the upper lip. The patient was admitted to the dept. of Plastic Surgery for direct suturing or reconstruction. Part of the upper lip was removed by the dogbite, and in such condition, it could not be used for reconstruction.
Patient Examination
The lesion on the lip accounted for close to half of the upper lip length and went through the skin, oral muscle and oral mucosa. A large part of the oral orbicular muscle was missing.
Pre-Operative Considerations
After consulting an expert in facial traumas, the Plastic Surgeon decided to perform direct suturing in 4 layers: The mucosa, the muscle, the dermis, and the skin. In case these sutures would not hold or the upper lip should become too short and distorted, a plan B would be reconstruction using an Abbé flap at a later stage.
Before and after
Procedure
Step 1: Cleaning and marking of vermillion border
The lesion was thoroughly cleaned and directly closed with absorbable sutures (vicryl 3-0) in the oral mucosa, the orbicularis oris muscle (vicryl 3-0), the dermis (vicryl 4-0), and in the skin with nylon (4-0).
- Notice the marking of the vermillion border (on the transition from the lip to facial skin). This marking is very important when adapting the sides of the lesion.
Step 2: The mucosal layer closed
Closure of the mucosal layer using absorbable vicryl 3-0 sutures
Step 3: The oral muscle adapted
Using 3-0 vicryl mattress sutures the muscle was firmly adapted.
Step 4: Skin closed
Using nylon 4-0 sutures the skin was nicely adapted. The vermillion border was gently adapted.
Step 5: Tape applied
Tape to ensure no stretching in both horisontal and vertical plane.
Step 6: Post-Operative Plan
The tape was removed after 10 days if possible.The nylon sutures was removed after 10 days if possible. Antibiotics with penicillin 1million international units x4 daily for 7 days
Step 7: Follow-up after 3 months
At follow-up in the outpatient clinic the patient was satisfied with the result and had no infections. We found no indication for further recontruction with a flap and the patient was completed from our dept. of Plastic- and Reconstructive Surgery.