Abstract
A 19-month-old boy was bitten by a bull terrier,sustaining complete avulsion of his nose (Figs. 1and 2). He was taken immediately to the localaccident and emergency unit with his avulsed noseretrieved on ice. He was initially managed by oro-tracheal intubation to protect his airway frombleeding, before transfer to the Regional PlasticSurgery Centre, arriving 3 h after the injury.The avulsed nose and facial wounds wereexplored in theatre. The ‘‘amputate’’, comprisingthe entire nasal skeleton and soft tissues, measuredabout3 cm 3.5 cmandtheonlyvesselidentifiablewithin it was the right lateral nasal vein (0.6 mmexternal diameter).Therightfacialartery(0.7 mmexternaldiameter)was mobilised and reflected caudally. A microvascu-lar artery-to-vein anastomosis was performed with10/0Ethilon
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