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 that she was the victim of a devastating dog bite less than a month ago. Then you notice the leg brace that doesn’t slow her down a bit, and the swollen left cheek.

Five days before Christmas, she was happily playing with kittens in her grandmother’s backyard. When her 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 Michelle De La Cruz, her mother, when she saw the extent of the injury. They were airlifted from San Leon to John Sealy Hospital at the University of Texas Medical Branch in Galveston, where Dr. Andrew Zhang took charge of her care. A plastic surgeon specializing in hand and microsurgery, Zhang has extensive experience in the complex reconstructive techniques required in this case.

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

The first task was to take care of what was left of her cheek, cleanse the wound, assess and preserve blood vessels, salivary ducts, nerves and facial muscles. A few days later, 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 required to provide blood supply to the transplanted flap. Given Adrianna’s age, Zhang was working on blood vessels the width of a piece of angel hair pasta and using sutures about one-tenth the size of a human hair.

“Because she’s 4, it makes the microsurgery that much more difficult because the vessels are so small and so critically important in surgery,” he said. The vessels were sutured under nine times magnification.

While a simple skin graft would have repaired the wound, she 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 this 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 her 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 and the ability to help.

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

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At a glance:

Every year, 4.7 million people are bitten by dogs in the United States. Children are the most common victims and more than three times as likely to be bitten as adults. In fact, half of all children will be bitten by a dog by the time they are seniors in high school. 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 and the American Society of Maxillofacial Surgeons have joined a national initiative to raise awareness of this public health problem. In conjunction with the AVMA and the United States Postal Service, they sponsor National Dog Bite Prevention week in May. Information is available at www.avma.org.