I had to repair a quilt I had made for my niece after the dog chewed a hole. Machine pieced and hand quilted. Fortunately I had leftover fabric from that quilt to replace the pieces. I removed the quilting from several inches around the chewed spot. Sewed the patch to match the pattern where needed. From the back side, hand-sewed the patch into place on the top. Got a scrap of batting and tacked that into place. Made a patch for the backing and hand sewed that into place. The hand quilting was of an overall design so just got my template out, lined up with the existing quilting and requilted that portion. By the time it was done it was virtually impossible to find the patch.