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Lip replantation in an infant after prolonged ischemia: age as a factor affecting success.

Lip Replantation in an Infant after Prolonged Ischemia: Age as a Factor Affecting Success Sir: W present a case of successful lip replantation in an infant with a large tissue loss after prolonged ischemia time. A 21-month-old girl was transferred after a lip and cheek amputation secondary to a dog bite (Fig. 1). Total ischemia time was 9 hours before successful arterial anastomosis. During the subsequent 2 weeks, the lateral aspect of the replanted part (i.e., tissue lateral to the vertical laceration within the replant) (Fig. 2) showed progressive, superficial necrosis. On postoperative day 18, a full-thickness skin graft was used to replace this area of lateral cheek skin loss that had been débrided. At 3-month follow-up, the child had a competent oral sphincter without macrostomia, although she had some slight subcutaneous thickening at the site of the skin graft. Prolonged ischemia is associated with an increased chance of replant failure, primarily because of avulsed Fig. 1. Upper lip and cheek defect. The defect involved approximately 7 cm2 of the cheek adjacent to the commissure and the entire half of the left upper lip. Inset shows amputated part previously transported in cold, wet gauze (cold ischemia time, approximately 8 hours; warm ischemia time during microanastomosis, approximately 1 hour).