Microsurgical Replantation of the Amputated Nose

After studying this article, the participant should be able to: 1. Determine which patients are suitable candidates for nasal replantation. 2. Appreciate the difficulty and challenge that is required to replant specialized facial structures. 3. Realize that the replantation of specialized facial structures may result in extensive blood loss. 4. Formulate an educated decision regarding the decision to replant an amputated nose versus the possible risk of blood transfusion and transmission of blood-borne diseases. A case of successful replantation of the nose is presented. Two arteries and one vein were anastomosed, providing a stable framework for direct revascularization of the amputated nasal segment. This resulted in complete survival of the nose, with an excellent aesthetic result. However, despite successful microsurgical arterial and venous repair, significant postoperative blood loss still occurred as a result of anticoagulation. In cases of the amputation of specialized structures, the improved functional and cosmetic result obtained with replantation must be weighed against the risk of blood-borne disease transmission when postoperative transfusion is required. Recognizing the potential need for postoperative transfusion in these cases is important in allowing the surgeon to exercise appropriate judgment in deciding whether replantation should be performed.