My Dog Bit off my Top Lip

The reconstruction of the lip depends on the amount of tissue that survives. To some degreee this may be apparent as early as 5 days but may take at least 10 days to make a full assessment. However, gentle wound care and dressing changes may be advised for weeks or months prior to any additional surgery. The key issue now is: how much tissue survived.

When a dog bites off a portion of the lip and really
traumatizes it, its survival becomes somewhat difficult, but not impossible. At
this point, don’t be discouraged. When tissue is replanted, the most
appropriate follow up is to very carefully observe this and very gently cleanse
it. You will be amazed how much actually does survive, and in the long term how
good it can look. Initially they do look terrible and they often look somewhat
dead with dark coloration, duskiness and crusting. This often resolves and
leaves a result that is remarkably good.

From your description, it sounds like you have lost a segment of lip containing the skin (white part), vermilion border, and vermilion (pink part). When the tissue is relatively preserved and not too chewed up (excuse the pun) it can be replanted as a composite graft. Factors such as smoking, medications, age, general health status, and post-reconstruction care (e.g., application of ice, etc.) all play a role in determining if this tissue will survive. You should ask your surgeon what additional reconstructive options might be considered if the tissue does not survive, partially or completely (e.g., local advancement flaps, etc.)

Regarding : "My Dog Bit off my Top Lip
Last week my dog bit me and took out a chunk of skin from my cheek and going into my top lip. I took the chunk of skin to the ER and a plastic surgeon sewed it back on but seem less than positive about the outcome. The skin chunk involves my very white skin going into the ridge of my lip and going into the dark skin of my lip. What is my best hope and what questions should I ask the surgeon when I see them tomorrow?"

Without a photograph it is hard to say both how the area could be reconstructed IF it failed to live AND how the flesh it doing. Strictly, speaking, the area of flesh was GRAFTED (placed back and held by stitches) instead of REPLANTED (which would involve using microsurgical techniques to hook up the blood vessels in the bit area before securing it in place). Replantation of the cheek is VERY hard to do and may not be possible with an animal bite. (It was attempted in a case of a woman whose face was bit off by a chimpanzee..) In your case, there was nothing to lose by attempting an auto grafting of the piece hoping that some or all would survive while covering you with antibiotics for possible infection associated with dog bites.

Your surgeon would need to look at the area and its color. By feeling its temperature, capillary refill time (area blanching to touch and then filling back) and judging the color he should be able to guess with a good deal of accuracy if the tissue is alive. If it is not, you need to discuss reconstructive surgery of the area.

Good Luck.

Dr. Peter Aldea

The survival of the reattached tissue depends on its size (thickness, width) and the vascularity of the surrounding healthy tissue. Sometimes cooling the reimplanted tissue with intermittent cold compresses can increase survivability by reducing its metabolism affording a longer time for the new blood vessels int grow into it..

If it does not survive or survives only partially then your surgeon will need to debride it by removing the dead tissue. Sometimes the remaining defect can be repaired immediately if the wound is clean and sometimes it is better to wait. Usually the sooner it is repaired the less scar tissue develops and the more obvious the reconstructive options are. Waiting too longer may distort things. Of course, some small defects can heal and not cause much detortion without further surgery.

When you see your plastic surgeon tomorrow, he will tell you how that replanted tissue looks.  If it's healthy (the tissue is surviving), then he'll likely just let the scar mature over time (9-12 months), then do any necessary revisions. If the replanted tissue is not surviving, he may cut some or all of it out, then proceed with some other type of reconstruction.  I'm certain he will discuss this with you when he sees you.