Immediate Flap Repair of Pediatric Dog Bite Lip Avulsions

Abstract

Objective: 1) Recognize the operative technique for performing the split orbicularis oris myomucosal flap. 2) Identifiy candidates for repair using split orbicularis myomucosal flap. 3) Understand the utility of the split orbicularis oris myomucosal flap in the repair of complex dog bites of the flap.

Method: Case series of full thickness pediatric lip avulsion injuries secondary to dog bites with immediate flap reconstruction. Cases were reviewed from the last 5 years at an academic institution. All procedures were performed by the same surgeon. Outcome measures included pre- and postoperative photographs as well as assessment of patient satisfaction.

Results: A total of 3 patients underwent immediate primary repair of complex dog bites of the lip using split orbicularis myomucoal flaps. All patients were admitted postoperatively for IV antibiotic therapy and were discharged within 1 to 2 days on a 7- to 10-day course of augmentin. No patients developed a postoperative wound infection. None of the patients required a scar revision procedure, and only 1 patient developed postoperative milia, which was managed in the office. Oral competence was maintained in all patients without any evidence of microstomia.

Conclusion: The split orbicularis oris myomucosal flap can be used to repair full thickness lip injuries secondary to dog bite injury. There is no evidence of increased postoperative infection when used for immediate reconstruction and oral competence is maintained. This flap provides good cosmetic outcomes without the need for scar revision.