Rejuvenation
Soft tissue nasal reconstruction after dog bite
Case Study: Plastic Surgery for reconstructing a traumatic dog bite injury to nose
A 43 year-old West Virginia woman was attempting to feed a friend's dog when the dog (Rottweiler) jumped up and bit off the woman's nose. The dog bite injury caused the loss of the nasal tip down to and through some nasal cartilage. The dog proceeded to eat the nose so it could not be reattached. Unable to locate a plastic surgeon to reconstruct the nose in West Virginia, a search in Northern Virginia was emergently begun.
INOVA Loudoun Hospital was contacted and they in turn contacted the Medical Director of The Loudoun Center for Plastic Surgery, Dr. Michael J. Brown. The patient was evaluated by Dr. Brown and arrangements were made to have the patient travel to Northern Virginia to undergo a staged nasal reconstruction to repair the dog bite injury.
This images depicts the loss of nasal tissue. The underlying cartilages are visible in the nasal wound. September 18, 2008. As a side note, this is the cartilage that can be adjusted during a cosmetic rhinoplasty.
In this photo, the patient is in the first stage operation and a plastic surgery forehead flap is drawn on her forehead. This tissue will remain attached to its blood supply near the eyebrow and rotated around to cover the nasal defect.
In these plastic surgery photos (above and below), you can see the flap inset onto the nose and it has been sewn into place. There is essentially a tube of skin, fat, muscle and blood vessels that are resting the nasal bridge. The defect on the forehead will heal in over time and will be further revised with additional stages of the plastic surgeries.
The tube is only attached in the area of the nasal amputation.
Here she is, 4 days later. Because of her smoking history she remained with this flap like this for 4 weeks. At that point, she was taken back to the operating room to thin the flap and put it back onto the nose. This allowed for the flap to lie flush with the thin nasal skin.
She developed a complication secondary to resumption of smoking after her second operation and lost part of the skin on her new nose. This required another trip to the operating room and her flap was raised again, trimmed and then attempted to be replaced. Despite only loosing 3 mm of tissue, it was in critical areas and her result was partially compromised. She remained with her nasal flap in place for another 4 weeks and then was ready for flap division.
She went to the operating room for the division of the flap with the left over tissue placed back in her forehead.
Here she is glad to have that flap stage completed. This photo is 5 days after the division and nasal tip reconstruction.
These are two months after stagged nasal reconstruction after dog bite. The flap remains swollen. This swelling will take a few more months to resolve. She may still require another revision if there is still a contour dissatisfaction.At this point, she is in no hurry for more surgery. All of her nasal reconstructions were performed at Inova Fair Oaks Hospital in Fairfax, Virginia.