My Dog Bit off my Top Lip

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.