Microsurgically aided upper lip replantation – case report and literature review

Figures & data

Figure 1. Preoperative picture showing the defect in the upper lip and the large laceration of the lower lip.

Figure 2. The amputated part of the upper lip, measuring 4.5 × 3 cm, was kept in a hypothermic state.

Figure 3. Shortly after the lip was reapproximated, venous congestion occurred. A leech was immediately applied and the lip regained normal color.

Figure 4. The patient at one year follow-up. The lip still has a slight edema, which is slowly subsiding.

Table 1. Lip replantation cases reported in English literature (n = 32).

CASE	Localization:	Type of trauma	Size of amputate	Ischemia time	Arterial anastomosis	Venous anastomosis	Leeches, time	Necrosis	Anticoagulants
1^4	Upper lip + part of nose	Dog bite	15 cm^2	3.5 h	One	One	No	Partial	Aspirin, dextran, heparin
2^5	Upper lip	Industrial accident	Not reported	5.5 h	One	One artery to vein	Yes, 10 days	None	Not reported
3^6	Lower lip + part of chin	Horse bite	Not reported	>8 h	One	One	No	None	Aspirin, dextran
4^7	Upper lip	Motor vehicle accident	Not reported	Not reported	One	None	Yes, not reported	None	Heparin
5^8	Upper lip	Dog bite	Not reported	6 h	Two	None	Yes, day 2–12	None	Heparin
6^9	Lower lip	Human bite	9 cm^2	8 h	One	One artery to vein	No, intra-replant heparin 9 days	None	Aspirin, dextran, heparin
7^10	Upper lip	Dog bite	10 cm^2	17 h	One	One	Yes, day 2–8	None	Not reported
8^11	Upper lip	Dog bite	16,5 cm^2	>6 h	One	One	No, mechanical pricking + topical heparin	Partial	Aspirin, heparin
9a^12	Upper lip	Dog bite	Not reported	Not reported	One	Two	Yes, 1 day	None	Heparin
9b^12	Upper lip	Dog bite	12 cm^2	Not reported	One	None	Yes, 5 days	None	Heparin
9c^12	Lower lip	Dog bite	8 cm^2	Not reported	One	None	Yes, 7 days	None	Heparin, dextran
9d^12	Upper lip	Dog bite	12.5 cm^2	Not reported	One	None	Yes, 6 days	None	None
9e^12	Upper lip	Dog bite	8 cm^2	Not reported	Two	One	Yes, 7 days	None	Heparin, dextran
9f^12	Lower lip	Dog bite	12 cm^2	Not reported	One	None	Yes, 4 days	None	Aspirin, heparin
9g^12	Upper lip	Dog bite	7,5 cm^2	Not reported	One	Two	Yes, 7 days	None	Aspirin, dextran, heparin
9h^12	Upper lip	Dog bite	36 cm^2	Not reported	One	None	Yes, 6 days + topical heparin	None	Dextran
9i^12	Lower lip	Human bite	12 cm^2	Not reported	One	One	Yes, 8 days + topical heparin	None	Aspirin, dextran
9j^12	Upper lip	Dog bite	3 cm^2	Not reported	One	None	Yes, 1 day	Partial	Heparin
9k^12	Upper lip	Dog bite	6 cm^2	Not reported	One	One	No	None	Heparin, dextran, coumadin
9l^12	Upper lip	Dog bite	6 cm^2	Not reported	One	None	Yes, 8 days	None	Heparin, dextran
9m^12	Lower lip	Human bite	10 cm^2	Not reported	One	One	No	None	Aspirin, heparin
10^13	Lower lip	Human bite	7.5 cm^2	>12 h	One, with vein graft	None	No, mechanical pricking + intrareplant heparin7 days	None	Aspirin, dextran, heparin
11a^14	Lower lip	Dog bite	Not reported	Not reported	One	None	Yes, 6 days	None	Not reported
11b^14	Upper lip	Dog bite	Not reported	Not reported	One	None	Yes, 6 days	None	Not reported
11c^14	Upper lip	Knife attack	Not reported	Not reported	One, with vein graft	None	Yes, 6 days	Partial	Not reported
12^15	Upper lip	Dog bite	Not reported	>7 h	One	None	Yes, 7 days	None	Not reported
13^16	Upper lip	Dog bite	7.5 cm^2	6 h	One	None	Yes, 12 days	None	Aspirin, heparin
14^17	Lower lip	Human bite	Not reported	Not reported	Two	None	Yes, 8 days	Partial	Aspirin, heparin
15^18	Upper lip + lower lip + nose	Bicycle accident	Not reported	Not reported	Two, with vein grafts	Two, one with vein graft	No	None	Heparin
16^19	Upper lip + lower lip	Dog bite	Not reported	4 h	One	One	Yes, not reported	None	Not reported
17^20	Upper lip + cheek	Dog bite	Not reported	9 h	One	None	Yes, 5 days	Partial	Not reported
18^21	Upper lip + nose	Dog bite	21 cm2	3 h	One	Three	No	None	Not reported

1–8, 10 and 12–18 being case reports, 9a–m and 11a–c being case series.