Microsurgical replantation after forehead avulsion - success or failure? A case report

In this article we would like to present, to our best knowledge, the very first published replantation of a forehead/part of a forehead as a single unit. The patient is a 57-year-old male smoker who sustained an avulsion forehead injury after a dog bite. Replantation was performed using microanastomosis of the supratrochlear vessels with restoration of good blood circulation after the procedure. Unfortunately, 5 days after the surgery, ischemia of the flap occurred followed by successful acute revision surgery. Nevertheless, the day after the ischemia reoccurred due to the time that passed, circumstances and unfavorable conditions affecting the sutured vessels, no further revision surgery was indicated. Observation continued and eventual wound necrosis after demarcation was left to be treated with skin grafting or per secundam intentionem. Only partial necrosis of the flap occurred, approximately 50%, which was subsequently treated with a full-thickness skin graft with very good results leading to the satisfaction of the patient.

Management of Human Bites in a Rural Kenyan Setting: A Plastic Surgeon's 8-Year Experience

INTRODUCTION

The treatment of human bites is a common issue facing healthcare practitioners in the developing countries of Sub-Saharan Africa where it has been noted as a growing public health concern. Generally, the desired outcomes from surgical management are healing, function, and aesthetics. We share our 8-year experience at Kapsowar Hospital in Kenya with the presentation, management, and outcome of human bites. We are uniquely situated to do so given the prevalence of human biting in our community and the full-time presence of a plastic surgeon at our institution. To the best of our knowledge, this study is the first to present human bite surgical management by a plastic surgeon certified by the American Board of Surgery working full-time on the African continent.

METHODS

A retrospective chart review was conducted on all patients who presented to the operating theater at Kapsowar Hospital with a human bite between 2013-2021. After identification of eligible patients, charts were reviewed assessing parameters including age, gender, timing from injury to presentation at hospital, localization of bite, severity of facial wounds using Lackmann's classification, surgical procedure(s), postoperative complications, surgical revisions, antibiotics administered, and circumstance of incident. Data were analyzed using SPSS 29.0.0.0.

RESULTS

Forty-four patients were identified. Seventeen (38.6%) were female and 27 (61.4%) were male. Thirty-one patients had facial bites and 13 patients had bites to other parts of the body. Of facial bites, 70.3% resulted in amputation of the affected part while 29.7% were lacerations. Using Lackmann's classification for facial bite severity, IIIA bites (complete avulsion) were most common for both males (9) and females (7). Females comprised 68.4% of total lip bite victims. Bites to the extremity were associated with late presentation and infection. We report a salvage rate of 85.7% for infected digits.

CONCLUSIONS

Compared with most other studies on human bites, our patient population presents with a higher rate of avulsive lip injuries, most commonly among women. Our postoperative infection rate is lower than many others reported in the literature. Satisfactory cosmetic outcome with low risk of infection can be achieved by following well-established principles of wound healing and tension-free closure.

Bite wounds to the hand - a review

Bite wounds occur as a result of bite by an animal or a human. They are relatively frequent due to the growing number of pets living with people, as well as from inadequate human-animal interactions. The knowledge of most surgeons about the management of these injuries is relatively outdated, whereas the current literature points to important changes in this field. The article presents several aspects concerning epidemiology, classification, bacteriology, and characteristics of bite wounds to the hand. Based on the actual literature, detailed rules for the management of these injuries are described. This information may prove useful in the daily practice of surgeons and doctors at emergency departments who are frequently faced with bite wounds.

Replantation of a lip thrown in the bin

Management of soft tissue avulsion after facial bites could be challenging in some situation. We presented the case of a 32 years old men suffering from a full thickness avulsion of the left lower lip and cheek after a dog bite. Even if the lip fragment was initially put on the bin, a microvascular replantation was performed. The vascularization was based on the left inferior labial artery. No veins were found. We used post-operative leech therapy to avoid venous congestion during 10 days. A large antibiotherapy was conducted. Adaptation of antibiotics blood concentration was also necessary due to the permanent bleeding caused by leech therapy. At the 6 month consultation, the patient recovered an impressive labial function and sensibility. Replantation gives the best functional and esthetical outcomes in these rare and complex cases. Artificial blood drainage, large antibiotic therapy and close post-operative follow-up are significant parts of the replantation success.

Circumstances of human conflicts with bears and patterns of bear maul injuries in Bhutan: Review of records 2015-2019

Bhutan is one of the biological hotspots in the world where humans and natural flora and fauna co-exist in close proximity. Bhutan is home to two species of bears: Sloth Bear and Himalayan Black Bear. Human conflicts with bears are reported from all over the country. This study describes the profile of the victims and the pattern of injury resulting from bear attacks and circumstances around human conflicts with bears in Bhutan between 2015 and 2019. This was a cross-sectional study with a review of hospital records of patients treated at the National Referral Hospital from 01 January 2015 till 31 December 2019. Data were extracted into a structured pro forma and entered into EpiData Entry 3.1 and analysed in STATA 13.1. There were thirty-four patients who were provided care for bear maul injuries, with an average annual caseload of 6.8 cases per year. The injury prevalence was 100% and the kill prevalence was 0%. Bear attacks were reported from fourteen of twenty districts of the country. The mean age of the victims was 49 (±13) years. Males (26, 76%) and farmers (26, 76%) were the common victims; the risk of bear attacks was 0.16 per 100,000 farmers per year. The commonest region of the body attacked was the face (29, 85%) and victims were provided emergency and rehabilitative care within and outside the country. Thirty-three victims (97%) were provided post-exposure prophylaxis for rabies. All victims received antibiotics despite the lack of national guidelines on the choice of antibiotics post-bear maul. Human-bear conflict is multi-faceted, puts a considerable strain on bear-conservation efforts and requires multi-disciplinary efforts in the prevention of human injury and socioeconomic losses.

Contaminated wounds: Effectiveness of debridement for reducing bacterial load

Surgical management of contaminated hand wounds may seem anecdotal, but such injuries actually account for an appreciable amount of the activity in emergency hand centers, and recommendations put forward by scientific societies differ. Dealing effectively with this public health issue calls for clarifying the usefulness of the various available treatments. Our study's objective was to determine the effectiveness of surgical debridement. In this prospective study, 92 patients with contaminated hand wounds underwent surgical debridement. Selection criteria included the length of time between injury and treatment, and the mechanism of injury. Patients with infected wounds, those treated by antibiotics, who were immunosuppressed or had osteoarthritis were excluded. Skin samples were collected both before and after debridement. In 62% of cases, the wounds were contaminated before debridement. Following the procedure, 87% of the bacterial smears were negative. The comparison between debridement and smear results was statistically significant (Student's t test, P<0.001). Surgical debridement, with appropriate irrigation, can effectively eradicate bacterial flora due to contamination.

Eyelid Lacerations Due to Dog Bite in Children

PURPOSE

To evaluate the nature and extent of lacrimal apparatus injury in children after eyelid laceration from a dog bite.

METHODS

A retrospective chart review of all eyelid lacerations treated between 1990 and 2012 at Boston Children's Hospital, Boston, Massachusetts, was conducted. Seventy-three patients who sustained an eyelid laceration due to dog bite were identified and were matched 5:1 with a randomly selected cohort of 365 patients from the group of 1,177 patients who had sustained eyelid lacerations from other causes during the same time period.

RESULTS

Of the 73 patients who sustained an eyelid laceration due to a dog bite, 26 (35.62%) had damage to the lacrimal apparatus. This was statistically significant when compared to patients who sustained eyelid lacerations from other causes, in which 13 (3.56%) patients had damage to the lacrimal apparatus (P < .000001). The inferior canaliculus was the most commonly involved site of lacrimal apparatus trauma as a result of a dog bite. Success was defined as lack of epiphora at the time of the last follow-up. Early surgical management of eyelid lacerations with lacrimal apparatus involvement had a success rate of 82%.

CONCLUSIONS

Eyelid lacerations due to dog bites have a greater prevalence of involvement of the lacrimal apparatus and especially the inferior canaliculus than lacerations due to other causes in children. Clinicians should have a high index of suspicion for lacrimal apparatus involvement and be prepared for surgical repair, if indicated.

The Management of Domestic Animal Bites to the Hand

Hand bites from domestic animals are extremely common. Though many may initially appear benign, it is important for treating physicians to be aware of the factors that place patients sustaining animal bites at additional risk for infection. As clinicians, we must be able to efficiently diagnose and treat these patients properly to avoid the morbidity that animal bites can provoke. The current paper reviews the evaluation and management of domestic animal bites to the hand.

Jaguar attack on a child: case report and literature review

Jaguar attacks on humans rarely occur in the wild. When they do, they are often fatal. We describe a jaguar attack on a three-year-old girl near her home deep in a remote area of the Guyanese jungle. The patient had a complex but, relatively, rapid transport to a medical treatment facility for her life-threatening injuries. The child, who suffered typical jaguar-inflicted injury patterns and survived, is highlighted. We review jaguar anatomy, environmental status, hunting and killing behaviors, and discuss optimal medical management, given the resource-limited treatment environment of this international emergency medicine case.

Dog bites of the head and neck: an evaluation of a common pediatric trauma and associated treatment

PURPOSE

To identify which patients and canines are involved in dog bites of the head and neck, and how they impact health systems.

MATERIALS AND METHODS

This is a single center, retrospective cohort study conducted from January 2012 to June 2013 in an academic, tertiary care center situated between multiple suburban and urban communities. Patients were identified by queried search for all bite-related diagnoses codes.

RESULTS

334 unique dog bites were identified, of which 101 involved the head and neck. The mean patient age was 15.1±18.1years. Of the more than 8 different breeds identified, one-third were caused by pit bull terriers and resulted in the highest rate of consultation (94%) and had 5 times the relative rate of surgical intervention. Unlike all other breeds, pit bull terriers were relatively more likely to attack an unknown individual (+31%), and without provocation (+48%). Injuries of the head and neck had an average follow-up of 1.26±2.4 visits, and average specialty follow-up of 3.1±3.5 visits.

CONCLUSIONS

The patients most likely to suffer dog bite injuries of the head and neck are children. Although a number of dog breeds were identified, the largest group were pit bull terriers, whose resultant injuries were more severe and resulted from unprovoked, unknown dogs. More severe injuries required a greater number of interventions, a greater number of inpatient physicians, and more outpatient follow-up encounters. Healthcare utilization and costs associated with dog bites warrant further investigation.

Animal attack: an unusual case of multiple trauma in childhood

A 2½ year old girl attended our facility following attack by a tapir at a city zoo. She sustained multiple injuries including a forearm laceration and multiple perforating wounds to her abdominal wall. She had several procedures, including bowel resection, performed under the care of the General Paediatric Surgery and Plastic Surgery teams and was treated with a course of IV antibiotics. She recovered well and to date has suffered no long-term adverse outcome.

Reconstruction of upper lip avulsion after dog bite: case report and review of literature

IMPORTANCE

Upper lip avulsion after traumatic dog bite is a serious cause of facial disfigurement for which there is no consensus on management in the acute setting.

OBJECTIVE

This review was prompted by a case at our institution and is intended to display the available evidence in the management of the patient after dog bite injury to the upper lip. Our main goals are to create a management algorithm using current evidence and to stimulate further clinical investigation to improve outcomes in patients with facial dog bite injuries.

EVIDENCE REVIEW

A review of English literature was performed using Pubmed/MEDLINE for case reports and case series of lip replantation using microvascular anastomosis. Additional review of hyperbaric oxygen therapy, medicinal leech therapy, lip reconstruction methods, and reapproximation was performed. Reference searches were performed for all retrieved articles.

FINDINGS

Microvascular replantation is a successful method of acute management in dog bite injuries of the lip. Hyperbaric oxygen therapy and medicinal leech therapy improve outcomes. Immediate cross-lip flaps and immediate reapproximation are alternative techniques that can be performed in the acute setting, but further investigation is required.

CONCLUSIONS

The repair of the upper lip after a dog bite is a priority due to the functional and psychiatric sequelae associated with facial disfigurement. Microvascular replantation should be considered first-line. Immediate reapproximation without microvascular reanastomosis and immediate reconstruction may also be performed. A stepwise clinical algorithm may aid the surgeon in the acute management of dog bite trauma to the lip.

Management of penile trauma caused by a dog bite

BACKGROUND

Dog bites to the external genitalia are extremely rare. The literature shows only sporadic cases of penile injuries due to dog bites, presenting mostly as children and adolescents.

CASE PRESENTATION

We report the case of a 45-year old patient with avulsion and traumatic de-gloving of the penile skin, with exposure of the tunica albuginea, which surrounds the cavernous bodies.

CONCLUSION

Dog bite wounds pose a serious medical threat. An effective initial treatment of the wound, as well as adequate supportive treatments are essential for the efficient healing of the resulting infection.

Traumatic avulsion and bilateral eye loss: report of two cases

BACKGROUND

The optic nerve and the globes are resistant to mild to moderate trauma and bilateral avulsion of the eyes is rare with only a few cases reported in the literature.

CASE

We report two cases of traumatic bilateral eye avulsion. The first case was secondary to a bear bite and was managed successfully, although the eyes were not salvageable whereas the second case which was due to physical assault expired due to associated severe head injury.

CONCLUSION

Traumatic bilateral globe avulsion/loss is a rare complication of trauma. In developing countries like Nepal, poverty, forest encroachment activities, extensive deforestation, frequent domestic disturbances and lack of education are some of the circumstances that increase the probability of such visual injuries.

[Face replantation using labial artery for revascularization. Case report]

BACKGROUND

Restoration of the face function and cosmetic appearance after a traumatic complex wound is a challenge for the plastic surgeon. Worldwide, few cases have been reported about face replantation.

OBJECTIVE

To present the case of the first partial face replantation reported in the national bibliography, using the labial artery for revascularization.

CLINICAL CASE

On June 19th 2011, a 7 years old male presented to the emergency room of the Mexican Institute of Social Security at Monterrey, Mexico, 4 hours after a partial face amputation secondary to a dog bite. The amputated segment was composed of 75% of the upper lip, 33% of the lower lip, oral commissure and 75% of the left cheek. The labial coronary artery and vein were anastomosed with 11-0 nylon sutures and the miorraphy of the orbicularis oris, the depressor anguli oris and the depressor labii inferioris with 4-0 vycril sutures. Six months after the surgery, the functional and aesthetic outcomes were excellent with reestablishment of total labial continence and total recovery of articulation of words.

CONCLUSIONS

amputations of any facial component should be initially managed with replantation. The function and cosmetics are better than any other technique of reconstruction. The labial coronary artery is an excellent choice for revascularization up to 25% of the face (lips and cheek).

Small-wave plasty for correction of lip length deficiency: a case report

BACKGROUND

Lip reconstruction may lead to disappointing results due to secondary deformity and visible scars. The Z-plasty in the Tennison technique is an effective method for repairing the upper lip subunits. The main issue is the visible and ungracious scar.

METHODS

A 38-year-old woman was treated for an upper lip deformity secondary to a dog bite injury. At 1 month after a direct suture, a scar contracture with a defect of Cupid's bow and a vermilion height deficiency occurred. A Tennison procedure was chosen to repair the deformity. A small-wave incision procedure also was considered to minimize visibility of the scar. These two techniques were coupled in a small-wave plasty. The small-wave plasty design was performed with a superior flap base (L1) of 7 mm and a circle arc of 10 mm. The superior height (H1) was 3 mm. The middle flap base (L2) was 4 mm, and the circle arc was 6 mm. The middle height (H2) was 2 mm.

RESULTS

The surgery time was 55 min with the patient under general anesthesia. The skin healing was completed in 10 days without scar contracture. The upper lip subunits were reconstructed with a regular Cupid's bow and a symmetric vermilion height. The scars were slightly visible at 1 month postoperatively. The results were stable after a follow-up period of 12 months. No revision was needed.

CONCLUSION

The small-wave plasty, which couples a Tennison technique with a small-wave incision procedure, is efficient in reconstructing the subunits of the upper lip after a scar contracture deformity. This method should be used for upper lip reconstruction for minimal scar visibility. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Breast amputation correction of a horse bite using the lipomodeling technique

Mammary gland development is an important phase of puberty, and it marks the passage into adulthood for women, so any trauma leading to mammary deformities has an important physical and psychological impact. Often, classic techniques are difficult to use in the treatment of traumatic breast lesions. In this article, the authors present an exceptional case of breast reshaping by lipomodeling in a teenage patient who had experienced a horse bite. Treatment included 2 fat grafting sessions with fasciotomies, nipple reconstruction using a bifoliated flap, and areolar tattooing, all without any complications. We achieved a satisfactory result with a symmetric volume, a natural tissue consistency, and sensation improvement, all of which were maintained as the patient grew. In our experience, fat transfer was a safe and reliable technique that provided a good and stable aesthetic result, improving the volume and shape without additional scarring or implant devices.

LEVEL OF EVIDENCE

5.

Periorbital trauma from pit bull terrier attacks

PURPOSE

To report the nature of periorbital trauma after pit bull attacks. While these attacks have been well-characterized in the popular media, no case series has documented the ophthalmic manifestations of this trauma.

METHODS

We retrospectively reviewed all cases of pit bull terrier attacks that presented to the oculoplastic and orbital surgery service at Albany Medical Center between 2008 and 2011. The age, gender, extent of the injuries, care provided, follow up interval, and complication rate were evaluated for each patient.

RESULTS

Seven patients were identified, with a mean age of 17.2 years. Six of the seven patients were in the pediatric age group. All patients suffered eyelid lacerations, and only one patient had additional injuries. Four patients (57.2%) suffered a canalicular laceration. Despite the lack of post-operative oral antibiotic use, no patient developed a wound infection.

CONCLUSIONS

In the ophthalmic setting, pit bull terrier attacks most frequently involve children and result in eyelid lacerations. Canalicular injuries are common after these attacks.

Successful replantation of a completely amputated ear on a child

Amputation of an ear is a rare injury. Subsequent replantation is a challenging and very difficult task for an experienced micro-surgeon. Every well described successful replantation of an ear is a valuable lesson for a micro-surgeon mainly because securing the venous drainage of the replanted ear is very difficult. In the worldwide medical literature, only a minimal amount of cases have described a successful replantation of an ear after total amputation on a child. The authors describe the whole treatment process for a seven-year old boy whose ear was bitten off by a dog. They also describe their procedures which led to a successful outcome.

Bites to the hand: are they more than we can chew?

Animal bites to the hand caused by dogs, cats and humans are common conditions that general practitioners, emergency physicians and hand surgeons encounter in their practice. These bites are prone to infection and represent great cost to the patient in terms of time, money and disability, if not treated optimally from the outset. Other than lacerations to the skin, injuries to the tendons, nerves, bone and joints are commonplace given their proximity to the skin surface in the hand. Optimal treatment of acute animal bites to the hand should include clearance of contamination by surgical debridement, prophylactic antibiotics and tetanus toxoid, as well as staged reconstruction of all damaged tissue, including the skin, once the wound is deemed clean.

[A rare case of fatal outcome due to extensive facial trauma caused by dogbite]

Statistically 10% of head and neek trauma is caused by animal bite, more often inflicted by dogs. More than 50% of victims are infants and small children. Generally, the result of dogbite is superficial trauma but there are cases of deep soft tissue defects with amputation and multiple bone fractures. In case described in this article, an elderly woman suffered a dog attack, wich resulted in extensive face and head injuries. In spite of receiving proper treatment, the patient passed away. It is highly probable that underlying Syncumar therapy caused complications which contributed to the fatal outcome. Because of it's unusual nature we found this case to be of interest for publication.

Management of facial bite wounds

Bite wounds are especially prone to infectious complications, both local and systemic. In bite wounds to the face, such complications can create more difficulties than the initial tissue damage itself for the task of restoring an esthetic appearance. Management should aim to neutralize this potential for infection and provide an infection-free environment for wound healing. Wound cleansing followed by primary closure is the treatment of choice, and the use of prophylactic antibiotics may further decrease the risk of infection. Delay in presentation beyond 24 hours is not necessarily a contraindication to immediate repair, but excessive crushing of the tissues or extensive edema usually dictates a more conservative approach, such as delayed closure.

[Bite wounds of maxillofacial area: situation analysis for the Tver region]

489 cases of references concerning the bitten wounds of maxillofacial area for the period of 1998-2008 were analysed. The analysis has shown that 77 (15,7%) cases with localization of the bitten wounds on fase had long, serious functional - aesthetic infringements, and the majority of cultural and life conditions questions, analyzed behavioural aspects of the population of the Tver region, remained unresolved actual problem.

[Serious dog bite lesions in childhood: presentation of 3 cases and literature review]

Animal bite lesions in the pediatric patient are mainly accounted for by dog bites in 80% to 90% of the cases. They often present a favorable prognosis but serious lesions do account for 5% to 20% of the total incidence. We will present three particular clinical cases which required urgent surgical treatment as well as a review of the current literature to include both medical and surgical treatment methods for this kind of lesion.

Dog bite causing ischemia and neurological deficit at the upper extremity: a case report

We present a case with median and radial nerve injuries together with brachial artery occlusion after a dog bite that is seen rarely in the literature. A 26 year-old man was admitted to our emergency department with a complaint of dog bite and weakness of fingers at the left upper extremity. There were bite impressions at the left arm. The physical examination of the patient revealed no brachial and radial artery pulse. The neurological examination revealed radial and median nerve deficits. The patient underwent a thromboembolectomy operation following laboratory and radiological evaluations. The nerve injuries were evaluated as partial and medical treatment was administered.

Catfish stings and the venom apparatus of the African catfish Clarias gariepinus (Burchell, 1822), and stinging catfish Heteropneustes fossilis (Bloch, 1794)

The ability of catfish to inflict extremely painful wounds with their pectoral and dorsal stings has been well known for many decades. The venom apparatus of the African catfish Clarias gariepinus (Burchell, 1822), and stinging catfish Heteropneustes fossilis (Bloch, 1794) is constituted by a single, sharp and stout sting immediately in front of the soft-rayed portion of the pectoral fins. The sting has well developed articulations, making it possible for it to become erect and locked. The toxicological centres in Poland have recorded 17 cases of envenomations caused by stinging catfish and African catfish; the injury was accompanied by intense pain, numbness of the site, dizziness, local oedema and erythema. In addition, systemic symptoms such as tachycardia, weakness and arterial hypotension were observed. The treatment of these injuries should include cleansing of the wound and surrounding area. Immersion of the wounded extremity in hot water (45 degrees C) was used for the pain control. An attempt to remove any spinal sheath or remnant must be undertaken. Antibiotic management depends on several factors: the age and immune status of the victim, the interval between injury and presentation, or the presence of a foreign body. The most serious long-term complications of sting envenomation involve infections.

Penetrating injuries in dogs and cats. A study of 16 cases

The objective of this retrospective study was to assess radiographical and surgical findings, surgical management and outcome of penetrating injuries in dogs and cats by evaluating patient records. Sixteen patients were identified (15 dogs and one cat), four with gunshot wounds, and 12 with fight wounds (11 with bite wounds, one struck by a claw). The thoracic cavity was affected in six patients, the abdominal cavity in three cases. Both cavities were affected in five dogs and the trachea in two cases. All of the patients with fight wounds were small breed dogs. Multiple injuries to internal organs that required intervention were found surgically after gunshot wounds and a high amount of soft tissue trauma requiring reconstruction was present after fight wounds. Radiography diagnosed body wall disruption in two cases. All of the affected thoracic body walls in the fight group had intercostal muscle disruptions which was diagnosed surgically. Fourteen patients survived until discharge and had a good outcome. In conclusion, penetrating injuries should be explored as they are usually accompanied by severe damage to either the internal organs or to the body wall. A high level of awareness is required to properly determine the degree of trauma of intercostal muscle disruption in thoracic fight wounds.

[Surgical treatment in severe dog bites injures in pediatric children]

INTRODUCTION

We report a retrospective study of dog-bitten-children who underwent surgical treatment in our department between 1995 and 2005. We checked the different surgical techniques used to cover the defect as well as short and long-term functional and aesthetic results, considering also infection and hospital stay.

MATERIALS AND METHODS

During this period of time, 21 patients received surgical treatment because of dogs bites. Surgical approach was decided considering location and severity of lessions.

RESULTS

Our serie consists of 12 males and 9 females. Head (71%) and extremities (23%) were the most frequent affected areas. Primary closure was carried out in 18 cases and in the remaining 3 artificial skin or tissue flaps were needed; in these 3 cases the resulting scar was later removed. Surgical infection occurred in less than 10% of the children and in all cases, long-term aesthetic results were considered excellent.

CONCLUSIONS

Primary closure of dog-bites-injures improves functional and aesthetic results and reduces the surgical procedures in those patients.

Severe abdominal dog bite wounds in a pregnant cat

Bite wounds are one of the most common reasons for admission of cats to veterinary clinics. Appropriate wound management seems to be more important in the successful outcome of bite wound injuries than antibiotic therapy alone. This report describes a heavily pregnant cat that suffered severe abdominal bite wounds necessitating treatment with extensive surgery. A necrotic herniated kidney, abdominal wall hernias, internal peritoneal ruptures and fracture of the thirteenth rib, gravid cornu rupture, an extrauterine dead foetus and its free kidney were all observed at laparotomy. At surgery the extrauterine dead foetus was removed, and two live foetuses were retrieved by en bloc ovariohysterectomy. A right nephrectomy and partial costectomy were also performed. Two weeks postoperatively, the cat had fully recovered without a problem. Bite wounds encountered in cats, though severe and invasive, can be tolerated and extensive surgical management can result in successful outcomes even under suboptimal conditions.

[Vermilion reconstruction after dog bite injuries]

Dog bite injuries often concern the lips. In children, injuries of the face are most common, but also in adults so-called kissing injuries frequently happen. All-layer defects are treated by wedge excision in minor cases and by myocutaneous flaps in major cases of lower lip injuries, whereas upper lip defects are reconstructed by exchange flaps. If only the vermilion is concerned, mucosal flaps according to the von Esmarch technique yield very good aesthetic results with excellent function and without impairment of the mouth opening.

Clinicopathologic Monitoring of the Skin and Oral Mucosa of the First Human Face Allograft: Report on the First Eight Months

BACKGROUND

The first human face allograft was performed in France on November 27, 2005. We report herein the clinicopathologic findings from the skin and oral mucosa of this allograft during the first eight months.

METHODS

Sequential biopsies were taken from the facial skin (n = 3), oral mucosa (n = 20), and sentinel skin graft (n = 11) from day 3 to day 220 postgraft and examined (immuno)histologically, using a pathological score previously proposed for evaluation of rejection in composite tissue (hand) transplantation.

RESULTS

The patient developed clinically rejection episodes at day 20 and during the eighth month postgraft, manifesting with redness and edema of the facial skin, oral mucosa, and sentinel graft skin. Pathologically, changes suggestive of rejection grades 0, I, II, and III were seen in 1, 1, 1, and 0 biopsies of facial skin, 7, 2, 1, and 1 biopsies of sentinel skin graft and 3, 5, 8, and 4 biopsies of oral mucosa, respectively. Pathological changes were generally more severe in the oral mucosa than in facial and sentinel graft skin (mean scores 1.85, 0.64, and 1, respectively).

CONCLUSIONS

As it happens with other composite tissue allografts, close clinicopathologic monitoring of the skin (and oral mucosa) seems to be the most reliable way to detect rejection in the setting of human facial tissue allotransplantation. Apart from these rejection episodes, the skin and mucosa maintained a normal microscopic structure, paralleling functional recovery.

Versatility of the Bilobed Cervical Skin Flap for Total Ear Reconstruction in the Unfavorable Temporoauriculomastoid Region

BACKGROUND

The unfavorable temporoauriculomastoid region is a serious clinical problem that makes total ear reconstruction a real challenge. In patients who have it, all local flap solutions to provide skin coverage to the cartilage frame are precluded because of loss and/or severe scarring of the regional skin in association with loss of the axial vascularity of the region. In the current literature, all available techniques for these patients are lengthy and risky free flap procedures that can provide a poor quality of skin coverage with no aesthetic harmony at best. In this article, the authors describe the use of the bilobed cervical flap as a new technique for providing skin coverage in total ear reconstruction for patients with an unfavorable temporoauriculomastoid region.

METHODS

Over a period of 6 years, the technique was used in seven patients between the ages of 19 and 52 years. In all patients, the entire skin of the temporoauriculomastoid region was either lost or badly scarred. Moreover, use of the ipsilateral temporoparietal fascia was not possible because of impaired axial vascularity of the region.

RESULTS

Except for mild venous congestion at the distal part of the primary flap, the flaps healed uneventfully in all patients. The patients were followed up for 1 to 4 years. The results were excellent in all patients.

CONCLUSIONS

Providing a thin, pliable, hairless, and well-vascularized skin cover with a perfect color match, the bilobed cervical flap seems to be a useful solution to overcome the skin coverage dilemma in patients with an unfavorable temporoauriculomastoid region.

Soft tissue pediatric facial trauma: a review

Facial soft tissue injuries are common in pediatric trauma patients. Early diagnosis and definitive treatment as well as good postoperative wound care are important when dealing with soft tissue injuries, such as facial nerve and parotid injuries, animal bites, avulsive skin wounds and eyelid and ear lacerations. Children heal quickly, but they also tend to develop hypertrophic scars. Proper wound management during the healing period can help to minimize the risk of adverse scar formation. Dentists may be involved in the initial assessment of these patients. Knowledge of the diagnosis and management of soft tissue trauma is useful when dealing with pediatric patients and their parents postoperatively.