An accidental injury while playing with her dog nearly cost Amy Dorsen a sizeable portion of her upper lip, but quick thinking by her father and the all-out efforts of her medical team at Rhode Island Hospital helped her beat the odds with a successful reattachment.
PROVIDENCE â€” It took a top-notch medical team, a patient with unshakable optimism and a lightning-quick decision by her father to save Amy Dorsen’s upper lip.
Amy, 22, a recent college graduate from Warwick, was playing with Lucy, her Jack Russell terrier-pointer mix, in early June when the dog snapped at Amy and snagged her upper lip. As her dog Lucy moved forward, Dorsen jumped back, tearing her upper lip.
Amy clamped a towel over the wound and headed to Rhode Island Hospital with her parents, Ellen and David, when they hit heavy traffic. They called 911, and the dispatcher directed them to stop at the nearest fire station, on Park Avenue in Cranston.
As the Dorsens pulled up, one member of the rescue team asked, “Who has the lip?”
Amy’s parents asked, “What lip?”Â
David rushed back to their home in Warwick, where he found a fragment of Amy’s lip on the couch. What he did next proved to be pivotal: He placed the tissue in a bag, then surrounded the bag with ice. Had he put the lip directly on ice, it would have stuck to the ice and damaged the tissue.
“It looked like a chewed-up piece of gum,” David recalled.
Amy didn’t realize how bad the bite was until she looked in a hospital mirror. She steeled herself for the worst.
“My mouth was closed and my upper teeth were showing,” she said.Â
But Amy remained calm. “I’m a very positive person,” she said.
Dr. Paul Liu, chief of plastic surgery at Rhode Island Hospital, gave Amy two options: try to reattach the lip or undergo multiple surgeries to reconstruct it. The second option makes your mouth smaller, and, “the Cupid’s bow, the hollow above the upper lip, would be gone.”
Amy’s parents asked Liu what he would do if it were his daughter. Replant the lip, he told them. Amy decided to go for it.
But the procedure has a high rate of failure because doctors must reconnect the blood supply from the torn tissue to that of the existing lip. Normally, transplants involve larger body parts â€” a breast, say. This lip fragment was smaller. Further complicating matters, the only blood vessel connecting the missing part of the lip and the existing one was tiny â€” the size of a couple of strands of filament wire.
Working with Dr. Dan Kwan, the chief of reconstructive surgery for Lifespan, Amy’s doctors sewed the tissue in place and got the blood flowing into the lip. But doctors had to find a way to drain the blood out during the healing process, otherwise the lip would “blow up like a toad,” Liu said.
The doctors performed a procedure called chemical leeching. Every hour, a resident would prick the lip to keep it from swelling. They also injected a tiny dose of blood thinner.
“Three residents camped at her bedside for six days,” Liu said. “Every one to two hours, they would prick the flap to keep the tissue alive. On the morning of the seventh day, the lip pinked up on its own. That showed the lip was making new blood vessels.”
Liu credited the team of residents and ICU nurses with the success of Amy’s surgery.
“These are vanishing rare,” he said of the lip-attachment surgery. “When I was a resident, we did one with a world-famous microsurgeon. That was 30 years ago. He still shows that picture.” Â
Ten hours after the surgery, Amy took her first look in the mirror: “It was beautiful. My lip was completely perfect.”
That was before the swelling began, but now that’s completely disappeared.
The hard work was just beginning, however.
“I couldn’t eat, not even ice chips,” Amy said of the early days of her recovery. “The room was very hot because I couldn’t shiver. We didn’t want to constrict the blood vessel.”
Despite Amy’s injury, the family still has Lucy, one of three family dogs. Amy said it wasn’t the dog’s fault that she was bitten. She said she was in the dog’s face, and that Lucy had shown her teeth before biting Amy. Lucy had signaled to her that she wasn’t comfortable with the game.
Amy hopes to use this experience in her own healing work when she becomes a physical therapist.Â
“It helps to know that the body can do these amazing things,” she said. “I had to trust the process.”
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