Successful Non-Microvascular Nasal Tip Replantation After Traumatic Avulsion

摘要

Objectives: To present a case of a traumatic avulsion of the nasal tip treated successfully with non-microvascular replantation Methods: Illustrative case report Results: A 37-year-old male presented to Thomas Jefferson University Hospital with a traumatic avulsion of his nasal tip from a human bite. The avulsed tissue was 2cm in size, included the lower lateral cartilage and involved multiple subunits of the nose. Replantation was performed 8 hours after the traumatic incident. Leeches were applied to the re-implanted tissue immediately following surgical repair. Two weeks after surgery 80% graft survival was noted. The residual defect was reconstructed with a pedicled columellar graft. Conclusions: This case presents evidence that non-microvascular replantation of full thickness composite tissue can result in survival with acceptable clinical outcomes. In this particular case, tissue survival obviated forehead flap reconstruction and its associated morbidity. Future studies to determine the effects of time, size and leech therapy on replanted tissues are needed. Introduction Nasal defects created by traumatic amputation are much less common than those created by the surgical excision of malignancies. Flanery and others have shown that replantation of amputated nasal tissue is superior to other reconstructive efforts including local flaps and skin grafts when the defects are small in size. 1, 6, 7 However, when the defects are massive, replantation almost always results in necrosis. 9 Even with smaller defects replantation is often associated with partial graft failure and a high incidence of revision surgery. 7 A recent review of the literature of replantation of traumatic nasal tip injuries has revealed methods and complications associated with mostly microvascular repairs. We present a case of a traumatic avulsion of the nasal tip that was repaired by a non-microvascular technique with substantial survival. A review of the literature and discussion of indications and management of microvascular and non-microvascular replantation follows. Case Report A 37-year-old male presented to the Thomas Jefferson University emergency department following the traumatic avulsion of his nasal tip by a human bite during an altercation. The amputated nasal tissue was located several hours later at the scene of the altercation and brought to the emergency department, where it remained on iced saline until the time of surgery approximately 8 hours after the altercation. Physical examination at the time of presentation revealed a nasal defect encompassing the nasal tip with a portion of the right lower lateral cartilage, the soft triangle and a portion of the anterior columella (figure 1). No venous or arterial vessels were identified in the defect or amputated tissue for microvascular anastamosis. The amputated tissue contained skin, cartilage, and nasal mucosa and measured approximately 2.5cm x 2.5cm (figure 2).