# Surgical reconstruction of a W-shaped lower lip after extensive tissue loss and management of human bite wounds: A case report

## TL;DR

This case report describes a successful surgical method for reconstructing a lower lip severely damaged by a human bite using a W-shaped technique to reduce infection risk and improve healing.

## Contribution

The paper introduces a modified W-plasty technique combined with an arched counter incision to reconstruct traumatic lower lip injuries caused by human bites.

## Key findings

- The W-shaped excision technique effectively removed infected tissue and improved lip symmetry after a human bite.
- Combining W-plasty with an arched counter incision minimized mucosal damage and reduced the risk of multiple endobuccal lesions.
- The adapted surgical method provided short-term aesthetic results and promoted healing in a case of extensive tissue loss.

## Abstract

Human bites represent a considerable risk of infection, which negatively impacts the healing and reconstruction of the lower lip. This case report describes the effectiveness of combining surgical W reconstruction of the lower lip with specialized care to manage severe tissue loss due to biting.

A 22-year-old woman was bitten on the lower lip by her neighbor. A clinical examination revealed a wound with significant tissue loss on the right lower lip. To properly reconstruct and suture the wound edges, a W-shaped excision was performed to remove tissue suspected of harboring infection. Additionally, an arched endo-buccal counter-incision at the base of the mucosa was made to mobilize the tissue, ensuring lip symmetry. Appropriate treatment was administered for lesions caused by human bites.

The surgical W reconstruction of the lip technique is also used for excising tumors of the lower lip. Although there are other techniques for reconstructing the lip following tissue loss, the one described in this case offers an advantage in terms of ease of execution and reduced tissue damage.

After extensive tissue loss in the lower lip of a human being due to a human bite, this case report suggests that W reconstruction of the wound is a therapeutic alternative, giving short-term aesthetic results with a lower risk of infection.

•As human lip bites are frequent, the fusion of aesthetic reconstruction of the lower lip with the codified management of human bite lesions, after the loss of half of its constituent tissues, is necessary to combat superinfection and promote healing.•The advancement of the W-plasty technique for lower lip reconstruction, combined with an arched counter incision along the lower dental arch, enables mucosal mobilization while preserving tissue integrity, minimizing the risk of creating multiple endobuccal lesions.•This case report highlights how adapting a surgical technique, originally used for excising certain lower lip tumors, to reconstruct traumatic wounds or human bites with extensive tissue loss alongside key modifications to minimize buccal mucosa damage, can significantly enhance healing and aesthetic outcomes.

As human lip bites are frequent, the fusion of aesthetic reconstruction of the lower lip with the codified management of human bite lesions, after the loss of half of its constituent tissues, is necessary to combat superinfection and promote healing.

The advancement of the W-plasty technique for lower lip reconstruction, combined with an arched counter incision along the lower dental arch, enables mucosal mobilization while preserving tissue integrity, minimizing the risk of creating multiple endobuccal lesions.

This case report highlights how adapting a surgical technique, originally used for excising certain lower lip tumors, to reconstruct traumatic wounds or human bites with extensive tissue loss alongside key modifications to minimize buccal mucosa damage, can significantly enhance healing and aesthetic outcomes.