phenylephrine-hydrochloride and Amputation--Traumatic

Topics: Amputation, Traumatic; Bites and Stings; Facial Injuries; Humans; Nose; Rhinoplasty; Skin Transplantation; Wounds, Penetrating

We present a case of total amputation of a major portion of the nose of a 10-year-old boy, which was successfully replanted by microsurgical technique. A 489-year review of the literature revealed the rarity of successful nasal replacement following amputation.

Topics: Amputation, Traumatic; Child; Humans; Male; Microsurgery; Nose; Replantation

Topics: Amputation, Traumatic; Animals; Bites and Stings; Humans; Male; Nose; Replantation; Rhinoplasty; Skin Transplantation; Surgical Flaps

Although replantation of amputated facial segments remains challenging in reconstructive surgery, it offers excellent aesthetic and functional outcomes.. From May 2004 to October 2019, 12 patients underwent replantation of amputated facial tissues by supermicrosurgery. The case details, such as the rationale for replantation, the operation method, and postoperative therapy, are described. Four cases are discussed to demonstrate the replantation of different facial parts.. Facial tissue replantation was successful in all 12 patients without secondary surgery. The cases included the nose (1 patient), ears (8 patients), lips (2 patients), and one of the soft tissue segments surrounding the lower jaw. Venous congestion occurred in three patients who received a solitary arterial repair and were treated with bloodletting. All patients expressed satisfaction with the cosmetic and functional results at the final follow-up.. Supermicrosurgical facial tissue replantation is a promising and effective procedure for providing patients with the best aesthetic and functional outcomes.

Topics: Amputation, Traumatic; Humans; Microsurgery; Nose; Plastic Surgery Procedures; Replantation

Fortunately, traumatic total amputations of the nose are rare, especially in children. Their reconstructions generally require several operative steps, most often associating cartilaginous grafts (rib and/or concha), a free radial antebrachial flap for mucosal reconstruction and a frontal flap for the skin covering. These are therefore long and complex procedures requiring a trained surgical team and maximum patient adherence to their treatment plan. The clinical case described is that of an 11-year-old child presenting a sub-total amputation of the nose and having undergone reconstruction with skin expansion of the frontal flap due to a horizontal frontal scar of unknown origin and a particularly low hair implantation.

Topics: Amputation, Surgical; Amputation, Traumatic; Child; Forehead; Humans; Nose; Nose Neoplasms; Rhinoplasty; Surgical Flaps

A 21-year male, farmer by profession, was admitted in Plastic Surgery Department via outpatient department, with amputation of nose and upper lip with the knife during resistance against robbery attempt. He was having the blockage of the right side of nostril and difficulty in mouth opening. Upper lip vermilion and mucosal reconstruction with the bilateral facial artery musculo-mucosal (FAMM) flap and moustache reconstruction was done with visor flap. Split thickness skin graft (STSG) was done over the donor site. Division and insetting of visor flap was done after two weeks. After three months, all three nasal layers were reconstructed. The inner lining was reconstructed with the turn down flap, L-strut from rib cartilage, and the outer lining with forehead flap.

Topics: Amputation, Traumatic; Humans; Lip; Male; Nose; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps; Wounds, Stab; Young Adult

Injuries to the nose can be severe from both a functional and cosmetic perspective. After suffering a dog bite to the central part of the face, an 18-year old woman underwent replantation of the avulsed tissue with the help of microsurgical arterial anastomosis. A venous anastomosis was impossible and venous congestion was treated with leech therapy. Subsequent skin necrosis occurred after a few days and the replantation was revised, revealing healthy tissue immediately below. The defect was covered with a full-thickness skin graft. At follow-up review eight months later, the functional and cosmetic result was satisfactory. To our knowledge, this is one of few cases where an injury of this severity healed with a cosmetically acceptable result.

Topics: Adolescent; Amputation, Traumatic; Animals; Bites and Stings; Dogs; Female; Humans; Necrosis; Nose; Replantation; Skin Transplantation; Surgical Flaps

Topics: Amputation, Traumatic; Anastomosis, Surgical; Animals; Bites and Stings; Child, Preschool; Dogs; Humans; Lip; Male; Microsurgery; Nose; Replantation

The nose is one of the most important aesthetic units of the face. After a traumatic amputation, replantation is undoubtedly the procedure of choice, although, technically, very challenging. We report the 10-year follow-up of a partially digested nose replantation after a dog-bite in an 11-year-old boy using supermicrosurgery technique. Our report confirms that the microsurgical replantation of the nose can lead to an acceptable aesthetic result, with the sufficient growth of the replanted part in the following years. Besides the patient did not report sensibility disorders. The nose replantation in our opinion is the best reconstructive option to achieve an optimal aesthetic and functional outcome.

Topics: Amputation, Traumatic; Animals; Bites and Stings; Child; Dogs; Humans; Male; Microsurgery; Nose; Replantation

The nose is one of the most important aesthetic units of the face. Following traumatic amputation, although technically very challenging, replantation is undoubtedly the procedure of choice. We present the first successful replantation of a partially amputated nose subjected to an ischaemic time of over 12 h. The injury was sustained following a dog-bite and inter-positional vein grafts were used to re-establish both arterial and venous blood flow.

Topics: Adult; Amputation, Traumatic; Anastomosis, Surgical; Animals; Arteries; Bites and Stings; Dogs; Humans; Male; Nose; Replantation; Vascular Grafting; Veins

Successful microvascular replantation of amputated facial tissues has been sporadically reported in the literature, although most of these reports have concerned the reattachment of relatively small and segmental portions of the nose or nasal tip. We report the successful replantation of a traumatically amputated composite piece of tissue comprising the entire nose, most of the upper and lower lips, and the nasal boney and cartilaginous complex based on microvascular repair of the labial arteries and glabellar veins and discuss the results and implications of this experience.

Topics: Adult; Amputation, Traumatic; Facial Injuries; Humans; Lip; Male; Nose; Replantation

The nose is a central, prominent unit of the face. The surgical approach to complete nasal amputations is challenging and an experienced microsurgical team should always attempt microvascular replantation. This one-stage procedure could result in a superior clinical outcome compared to delayed reconstructive procedures. Two successful microvascular replantations of the distal half of the nose were performed. Both amputations were the result of two completely different aetiologies (sharp guillotine-like vs. avulsion trauma). However, we were not able to re-establish the venous drainage, which was managed through medicinal leeching. Both replantations resulted in an aesthetically pleasing result and no additional surgery was needed. A microsurgical replantation attempt should always be attempted in nasal amputations and the inability to perform venous anastomosis should not preclude the replant attempt.

Topics: Aged; Amputation, Traumatic; Bites and Stings; Child; Female; Humans; Male; Microsurgery; Nose; Replantation

The survival of a microsurgically replanted segment of nose in a 41-year-old woman was facilitated by the assistance of the medicinal leech Hirudo medicinalis. An arterial microanastomosis was made to a severed partial segment of nose with no possibility of recreating a venous anastomosis. The resulting venous congestion was treated with nine days of treatment with a medical leech until venous neovascularisation had been achieved. At follow-up six months after discharge there was a well-heeled nasal segment and a satisfying functional - as well as cosmetic - result.

Topics: Adult; Amputation, Traumatic; Anastomosis, Surgical; Animals; Bites and Stings; Dogs; Esthetics; Female; Follow-Up Studies; Humans; Leeching; Microsurgery; Nose; Postoperative Care; Replantation; Risk Assessment; Treatment Outcome; Wound Healing

The nose is a critical aesthetic subunit of the face, but because of the difficulties in anastomosis of the small-sized arteries and veins, several cases of nasal replantation have been reported. Using supermicrosurgical techniques, we successfully replanted a patient's nasal segment which had been amputated by a falling sharp metal pipe. The result was excellent both aesthetically and functionally, and the patient was very satisfied. The nose is located at the centre of face and is thus important aesthetically. The nose also has functions in olfaction, respiration, humidification, filtration, temperature regulation and phonation. However, the nose protrudes from the face and is readily injured by trauma, and in injured cases, reconstruction of the nose is essential. Recently, with the development of microsurgery, microsurgical replantation of the amputated nose has been reported.(1-11) We performed successful replantation of the nasal alar and tip that were completely amputated and smaller in size than previous reports, using a supermicrosurgical technique.

Topics: Amputation, Traumatic; Follow-Up Studies; Humans; Male; Microsurgery; Middle Aged; Nose; Replantation; Rhinoplasty

Topics: Accidents, Occupational; Adult; Amputation, Traumatic; Humans; Male; Nose; Replantation

Topics: Amputation, Traumatic; Humans; Male; Nose; Replantation; Surgical Flaps; Young Adult

Topics: Adult; Amputation, Traumatic; Bites, Human; Esthetics; Female; Follow-Up Studies; Graft Survival; Humans; Microsurgery; Nose; Replantation; Wound Healing

Nasal reconstruction using the forehead flap is one of the oldest recorded reconstructive procedures. The forehead flap is considered a standard for reconstruction of large defect. Most of reports concerning the forehead flap in nasal reconstructions deal with adults. Nasal reconstruction in infants raises some controversies, and very few articles report nasal reconstruction in the infants. A 15-month-old boy was presented after subtotal nasal amputation, after a dog bite. Microsurgical replantation was performed, but proved unsuccessful. The wound healed with debridement and local care. At age 2, nasal reconstruction was performed with autogenous ear cartilage and forehead flap. The reconstructed nose currently appears to be of good color, texture match, and functional. To our knowledge, few reconstructions of acquired nasal deformities using a forehead flap have been previously reported in infants. This 2-year-old patient may be among the youngest to have undergone this procedure. The forehead flap can be applied in very young children with reasonable expectations of excellent functional and esthetic outcome. Long-term results remain to be seen regarding nasal function and growth.

Topics: Amputation, Traumatic; Animals; Bites and Stings; Child, Preschool; Debridement; Dogs; Forehead; Humans; Male; Nose; Plastic Surgery Procedures; Surgical Flaps; Wound Healing

Topics: Amputation, Traumatic; Animals; Bites and Stings; Dogs; Humans; Male; Microsurgery; Middle Aged; Nose; Replantation

Successful nonextremity replantations, particularly of the facial anatomy and testicles, are rare procedures, and only a handful of cases have been reported. This article reviews the current literature in nonextremity replantations and representative cases performed at the authors' institution. Certain underlying themes and problems are consistently encountered in the surgical management of these cases. These are identified and reviewed. Although the replantation of these body parts remains technically challenging, all efforts should be made, when indicated, to repair these injuries microsurgically, because it currently offers the best reconstructive solution for these patients.

Topics: Adult; Amputation, Traumatic; Humans; Male; Microsurgery; Middle Aged; Nose; Replantation; Surgical Flaps; Testis; Transplantation, Autologous

Facial reconstruction with only free microvascular flaps has rarely produced an aesthetic result. Menick stated, "Distant skin always appears as a mismatched patch within residual normal facial skin." In addition, earlier techniques using a single large nasal lining flap or bilateral nasal lining vaults incurred a high incidence of airway obstruction.. The authors describe 10 consecutive patients requiring reconstruction of the nasal vestibule and columella lining from October of 1997 through May of 2005. Most of them also required reconstruction of the floor of the nose, the platform on which the alar bases and columella rest, and defects of the facial units adjacent to the nose. Aesthetic nasal reconstruction used two separate skin paddles to reconstruct the lining for the nasal vestibule and columella, an artistically constructed nasal framework made of cartilage, a forehead flap for cover, and other flaps and grafts to reconstruct adjacent facial unit defects.. The average patient age was 41.8 years (range, 10.4 to 65.3 years). Follow-up (from the time of the first operative stage) averaged 26.4 months (range, 4 to 49 months). Nine patients had functional airways, and one required nasal airway support with internal silicone tubes. At the time of publication, eight patients had normal-appearing noses, and two were awaiting secondary surgery to correct persistent deformity.. Microvascular free flaps have proved to be highly reliable and efficacious for restoration of missing elements of the nasal lining and adjacent facial soft-tissue defects in total and subtotal nasal reconstruction. Combined with a forehead flap, this aesthetic approach allows for reconstruction of the center of the face layer by layer and facial unit by facial unit. Specific attention is paid to the artistic creation of normal nasal dimensions, proportion, and form using carved and assembled cartilage grafts and by secondary subcutaneous contouring. In addition, this technique produces a patent airway.

Topics: Adolescent; Adult; Aged; Amputation, Traumatic; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cartilage; Child; Humans; Ischemia; Middle Aged; Mohs Surgery; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Flaps

A case of nearly complete amputation of the alar wing is presented whereby a successful arterial revascularization was accomplished using an arterial rerouting technique. Venous stasis was overcome by means of stab-wound wiping. An excellent result was obtained following complete survival of the revascularized segment. The authors conclude that microvascular revascularization should always be attempted whenever possible, even if a skin bridge is preserved in nearly complete amputations of the nose.

Topics: Adult; Amputation, Traumatic; Anastomosis, Surgical; Arteries; Facial Injuries; Humans; Male; Microsurgery; Nose

Osseointegrated maxillofacial epitheses are an interesting therapeutic response for rehabilitation after loss of facial tissue when reconstructive plastic surgery cannot be proposed. We analyzed the criteria used for deciding on this type of treatment for the loss of local areas of auricular tissue, the nasal pyramid and the orbitopalpebral region, presenting individual clinical examples.

Topics: Adolescent; Adult; Aged; Amputation, Traumatic; Carcinoma, Adenoid Cystic; Carcinoma, Basal Cell; Ear Neoplasms; Ear, External; Eye Neoplasms; Eye, Artificial; Eyelid Neoplasms; Female; Humans; Lacrimal Apparatus Diseases; Male; Middle Aged; Nose; Nose Diseases; Orbital Implants; Osseointegration; Patient Care Planning; Prostheses and Implants; Prosthesis Design; Prosthesis Implantation

Topics: Accidents, Traffic; Amputation, Traumatic; Female; Humans; Middle Aged; Nose; Replantation; Rhinoplasty

A case of successful replantation of the nose is presented. Two arteries and one vein were anastomosed, providing a stable framework for direct revascularization of the amputated nasal segment. This resulted in complete survival of the nose, with an excellent aesthetic result. However, despite successful microsurgical arterial and venous repair, significant postoperative blood loss still occurred as a result of anticoagulation. In cases of the amputation of specialized structures, the improved functional and cosmetic result obtained with replantation must be weighed against the risk of blood-borne disease transmission when postoperative transfusion is required. Recognizing the potential need for postoperative transfusion in these cases is important in allowing the surgeon to exercise appropriate judgment in deciding whether replantation should be performed.

Topics: Adolescent; Amputation, Traumatic; Humans; Male; Microsurgery; Nose; Replantation

A 41-year-old male participant of the 200 km Eleven Cities ice skating marathon in 1997 lost a large part of his nose tip as a result of hitting a bridge. Avascular replantation of the amputated nose tip combined with ice water cooling for three days did not result in revascularisation. Subsequently the entire nose tip was reconstructed by means of a paramedian forehead flap. This reconstruction was performed in three stages and had a good aesthetic result.

Topics: Adult; Amputation, Traumatic; Humans; Male; Nose; Rhinoplasty; Skating

Topics: Amputation, Traumatic; Anastomosis, Surgical; Arteries; Dermatologic Surgical Procedures; Follow-Up Studies; Humans; Male; Microsurgery; Middle Aged; Nasal Mucosa; Nose; Replantation; Vascular Surgical Procedures; Veins

To assess the effectiveness of replantation in the treatment of nasal amputations.. Retrospective chart review.. A university medical center.. In no case did the replant survive completely, and in all cases revision surgery was required. However, in all cases, the resulting deformity was less than the original defect. In our pediatric patients, reconstruction with cartilage grafting and a midline forehead flap was successful and demonstrated proportionate and appropriate growth.. It is our belief that replantation serves many therapeutic functions. At the very least, there is the psychological/emotional factor that is involved in attempting to replace a native body part that has been severed. Also, it is difficult to persuade parents and patients that the amputated tissue that has been handled with kid gloves by paramedics, maintaining its pink "alive" color, is ultimately doomed to failure. Forehead flaps and conchal cartilage grafts are more willingly accepted after a "failed" replantation than as primary reconstructions. In every instance, we believe, the ultimate defect will be smaller than the original deformity. Certainly, the need for vestibular lining reconstruction is far less. Thus, the ultimate healed defect from the replantation greatly facilitates final nasal reconstruction.

Topics: Aged; Amputation, Traumatic; Bites and Stings; Child; Child, Preschool; Female; Humans; Male; Nose; Replantation; Rhinoplasty

A new axial flap is described for reconstruction of soft-tissue defects of the nose, including the supratip and columella. The blood supply to this flap originates from the lateral nasal branch of the angular artery adjacent to the nasolabial fold. This flap was used in seven patients between 1989 and 1994, and there was complete survival. We recognized that this axial nasodorsum flap provided suitable shape design in each patient and produced excellent cosmetic results. The anatomy, the technique, and our clinical experience are presented.

Topics: Adult; Aged; Aged, 80 and over; Amputation, Traumatic; Arteries; Carcinoma, Basal Cell; Esthetics; Female; Graft Survival; Humans; Male; Middle Aged; Nose; Nose Deformities, Acquired; Nose Neoplasms; Surgical Flaps

Topics: Adult; Amputation, Traumatic; Bites, Human; Humans; Male; Microsurgery; Nose; Replantation; Suture Techniques

Local flaps offer the most suitable tissues for nasal tip reconstruction and with multistaged operative procedures excellent cosmetic results can be achieved in recreating the deficient nasal features. When local flaps or multistaged procedures cannot be performed, nasal tip reconstruction becomes a great challenge for the surgeon. A case is reported in which the dorsal skin of the second toe and the first two web spaces was transferred as a free flap over a framework of conchal and septal cartilage grafts to reconstruct a nasal tip.

Topics: Amputation, Traumatic; Foot; Humans; Male; Middle Aged; Nose; Rhinoplasty; Skin Transplantation; Surgical Flaps; Treatment Outcome

A challenge to the microsurgeon is perfecting the technique of replantation of small pieces of facial tissue, mainly because of the extremely small size of the arteries as well as a lack of suitable veins for drainage. In the past 4 years, we have had seven cases of facial amputations, which included one scalp, two nasal tips, two ears, one lower lip, and one eyebrow. All of these patients were replanted/revascularized by microvascular anastomosis. Only two of the cases had suitable veins for anastomosis. Alternative techniques used for improving venous outflow were arterio-venous fistula, chemical leeches, and pin pricks. Four of the cases were completely successful, two cases had partial loss of the replant, and one case failed due to absence of venous drainage. In facial amputation, an aggressive microsurgical attempt will result in more tissue surviving and a better cosmetic outcome than in any other reconstructive procedures.

Topics: Adult; Amputation, Traumatic; Bites, Human; Ear; Eyebrows; Facial Injuries; Female; Humans; Lip; Male; Microsurgery; Middle Aged; Nose; Replantation; Scalp; Treatment Outcome

Topics: Adult; Amputation, Traumatic; Follow-Up Studies; Humans; Male; Nose; Replantation

A simple method using ice-water and aluminium foil for enhancing composite graft survival is reported. Cooling the entire recipient site retards cellular degeneration in the graft until neovascularisation occurs. The success of this technique in nasal reconstruction using auricular chondrocutaneous tissue and nonmicrosurgical fingertip reattachment is presented. The potential application to thicker skin grafts is also discussed.

Topics: Adult; Amputation, Traumatic; Burns; Cartilage; Cryotherapy; Female; Finger Injuries; Graft Survival; Humans; Male; Nose; Postoperative Care; Skin Transplantation

Replantation of small parts often results in failure. The impractical size and the frequent absence of veins suitable for anastomosis, together with venous congestion and thrombosis, are the main problems. A case is described of an amputated nasal tip and successful replantation by means of microsurgical arterial repair and open venous drainage due to absence of suitable veins in the specimen. In cases in which there is no possibility of repairing the venous system, open venous drainage may be an easy and feasible method to prevent venous congestion and replant failure.

Topics: Adolescent; Amputation, Traumatic; Drainage; Humans; Male; Microsurgery; Nose; Replantation

Successful microsurgical replantation of a completely avulsed nasal tip is presented. The result is excellent. The technical challenge involved no sizable veins for drainage. This problem was solved by an artery-to-vein shunting. For facial avulsions, there is nothing superior to the original tissue, and replantation should always be attempted first.

Topics: Adult; Amputation, Traumatic; Arteries; Arteriovenous Shunt, Surgical; Humans; Male; Microsurgery; Nose; Replantation; Veins

Topics: Amputation Stumps; Amputation, Traumatic; Animals; Elephants; Female; Nose; Surgery, Plastic

Amputations of the nose and of the auricle present difficult management problems. Application of simple reattachment techniques, followed by aggressive medical therapy which consists of cooling, anticoagulation, antibiotic coverage, and multiple stab incisions in the amputated tissues, have resulted in the successful replantation of major portions of an amputated nose and an amputated auricle with satisfactory cosmetic results.

Topics: Adult; Amputation, Traumatic; Cryotherapy; Ear, External; Female; Humans; Male; Middle Aged; Nose; Replantation; Tissue Survival

Washio's temporo-retro-auricular flap was used to repair point of nose in three children and one ala nasi amputated by dog bites. Details of the technique are presented and long-term results discussed. Despite two inconveniences--dyschromia and relative stenosis of nares--this method compares favorably with other surgical procedures and over the time has proved to be one worth recommending.

Topics: Amputation, Traumatic; Animals; Bites and Stings; Child; Dogs; Ear Cartilage; Humans; Infant; Male; Methods; Nose; Surgical Flaps

The Authors present 808 replantations by microsurgery in patients aged between 16 months and 70 years. The functional results were controlled in 369 cases after 10 to 20 months. The less satisfactory function was found in patients over 50 years and following combined injuries of the hand. The replantation of the thumb achieved the best results. The Authors point out that, despite a poor prognosis, some replantations should still be attempted because every case needs to be evaluated individually.

Topics: Adolescent; Adult; Aged; Amputation, Traumatic; Child; Child, Preschool; Finger Injuries; Foot Injuries; Hand Injuries; Humans; Infant; Lip; Middle Aged; Nose; Replantation; Scalp

Loss of the nasal tip has a more disastrous effect on the face than the size of the deformity would suggest, thus reconstruction becomes vital. Immediate replacement of the severed piece is first choice. If this is not possible and the defect is no more than 1.25 cm at its thickest depth, an auricular chondrocutaneous graft is next choice. When the tip defect is more extensive, a midline vertical forehead flap or, in rare cases, an arm flap is indicated.

Topics: Adolescent; Adult; Amputation, Traumatic; Arm; Female; Forehead; Humans; Male; Middle Aged; Nose; Replantation; Rhinoplasty

Topics: Adult; Amputation, Traumatic; Animals; Bites and Stings; Bites, Human; Child; Child, Preschool; Dogs; Female; Humans; Infant; Nose; Skin Transplantation

A child had essentially her entire lip and most of her nose bitten off in one piece by a dog. This was replanted by microvascular anastomoses. Most of the fragment survived.

Topics: Amputation, Traumatic; Animals; Bites and Stings; Child, Preschool; Dogs; Female; Humans; Lip; Nose; Replantation; Surgery, Plastic

Topics: Adult; Amputation, Traumatic; Humans; Male; Methods; Nose; Replantation; Time Factors

Topics: Amputation, Traumatic; Carcinoma, Squamous Cell; Facial Injuries; Methods; Nose; Nose Neoplasms; Rhinoplasty; Skin Transplantation; Suture Techniques; Transplantation, Autologous

Topics: Amputation, Traumatic; Craniocerebral Trauma; Ear, External; Facial Injuries; Female; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Lip; Male; Maxillofacial Injuries; Necrosis; Nose; Replantation; Time Factors

Topics: Amputation, Traumatic; Epidermis; Humans; Nasal Surgical Procedures; Nose; Skin Transplantation; Wound Healing; Wounds and Injuries

Topics: Amputation, Traumatic; Humans; Nose