4-Year-Old Girl Recovers from Dog Attack at UTMB

Andrew Zhang, M.D. a plastic surgeon specializing in microsurgery, checks Adrianna De La Cruz’s progress after she underwent surgery to repair a devastating dog bite to her face.

By Maureen Bayless Balleza  |  UTMB in Galveston

Adrianna De La Cruz is a 4-year-old bundle of energy whose favorite word is “why.” At first glance it’s hard to imagine she was the victim of a devastating dog attack less than a month ago. Then you notice the leg brace that doesn’t slow her down a bit, and the swollen left cheek.
 
The day of the attack, Adrianna was happily playing with kittens in her grandmother’s backyard in San Leon, on Galveston Bay. When Adrianna’s brother came to feed the kittens, the unthinkable happened – her uncle’s golden retriever broke through a fence and attacked her, tearing off her left cheek.

“I flipped out,” said Adrianna’s mother, Michelle De La Cruz, when she saw the extent of the injury. Adrianna was airlifted from San Leon to John Sealy Hospital at the University of Texas Medical Branch in Galveston, where plastic surgeon Andrew Zhang, M.D., took charge of her care.

“When I saw Adrianna, I thought of my own children,” said Zhang, who has a 4-year-old daughter. “This is the kind of nightmare all parents fear.”

 The first task was to take care of what was left of Adrianna’s cheek, cleanse the wound, assess and preserve blood vessels, salivary ducts, nerves and facial muscles. Zhang gathered his team and began the intricate five-hour surgery to rebuild her face.

The team began by transplanting a flap of tissue from her thigh about the size of a slice of bread. This was then sutured and contoured to her face to reconstruct the missing cheek. The critical part was suturing the vein and artery that would provide a blood supply to the transplanted flap. Given Adrianna’s age and small stature, Zhang was working on blood vessels the width of a strand of angel-hair pasta and using sutures about one-tenth the size of a human hair. The vessels were sutured under nine times magnification.

While a simple skin graft would have repaired the wound, Adrianna would have been left with a cavity and unsightly scars on her face. Another option would involve rotating skin from her neck up to her face but that would have required multiple surgeries, and recent research indicates that multiple anesthesias can negatively impact a child’s development.

“I think the surgery we performed is the best solution to a difficult problem,” said Zhang.

The surgery was a success, aside from minimal swelling and some discoloration. Adrianna is back on her feet, as energetic as ever.

The dog that attacked, and was later euthanized, was known to Adrianna and had no history of violence. According to the American Veterinary Medical Association, most dog bites affecting young children occur during everyday activities and while interacting with familiar dogs.

For now, the De La Cruz family is just delighted with Adrianna’s progress.

“She’s healing very well,” said her mother. “They did an amazing job.” And Zhang is very pleased with the results.

“This is why I became a plastic surgeon,” he said. “To make my patients whole again.”

Each year, roughly 800,000 Americans will need medical attention for dog bites. More than half of those are children. The American Academy of Pediatrics, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, the American Society of Maxillofacial Surgeons and the American Veterinary Medical Association have joined a national initiative to raise awareness of dog bites as a public health problem. Information is available at www.avma.org/public/Pages/Dog-Bite-Prevention.aspx.