Dog bites are increasing in frequency and severity - a sustained effect following the COVID-19 pandemic.

The COVID-19 pandemic and subsequent lockdown measures have changed various aspects of society, including patterns of human-animal interactions. This audit investigates the incidence and severity of dog bites admitted under the plastic surgery department at a major trauma centre before and after COVID-19 lockdowns. We assessed trends in dog bite cases over the course of one year (2018) prior to the COVID-19 lockdown and one year after (2022). A time period during COVID-19 lockdown itself was not included to avoid confounding factors due to changes in healthcare provision during the pandemic. Our analysis reveals a 47 % increase in dog bites after lockdowns ended compared to before. We also demonstrate statistically significant increases in the need for operative management (90 % of patients compared to 78 %) and length of inpatient hospital stay (average 63 h compared to 51). Moreover we show that dog bites have increased in severity, with a clear increase in patients presenting with deeper tissue injuries, tissue loss and muscle, nerve, vascular or bone involvement. This represents a significant functional, cosmetic and psychological impact for patients as well as financial impact on the NHS and increased workload for plastic surgery departments. This is the first paper to examine the severity of dog bite injuries and to demonstrate a sustained effect even after the easing of lockdown measures. Our findings shed light on the potential impact of lockdown measures on human-dog interactions and highlight the importance of public awareness and prevention strategies in mitigating dog bites. LAY SUMMARY: Our study demonstrates that dog bite injuries increased in frequency by 47 % following COVID-19 lockdowns. Patients with dog bites are also being admitted for longer than before, requiring more operations and have more severe injuries, with some requiring skin grafting, nerve repair or more complex plastic surgery reconstruction.

The Double-Opposing Adipofascial Interposition Flap: A Novel Technique to Prevent Scar Tethering and Symptomatic Neuroma of the Superficial Radial Nerve After Trauma.

The superficial radial nerve (SRN) is vulnerable to injury following trauma with a high incidence of resultant nerve tether and neuroma formation. The SRN has an anatomical predisposition to neuroma formation, with research indicating that its propensity to neuroma development is out of proportion with its likelihood for injury. In addition, SRN neuromas have been described as one of the more painful and difficult neuromas to manage. Despite this, the published literature to date is chiefly focused on neuroma and scar tether treatment options rather than more impactful work on neuroma prevention, which can be safely delivered at the time of primary surgery. Treatment of established neuroma or nerve tether is notoriously difficult, and existing techniques have inconsistent outcomes, with patients often requiring multiple trips to the theatre. The authors present a novel technique for neuroma and scar tether prevention using an adipofascial flap accompanied by patient examples of our experience using this approach as an adjunct during the primary SRN repair, creating a gliding, interposing layer to prevent subsequent nerve traction pain and symptomatic neuroma. We identified five patients presenting with dorsal wrist injuries involving the SRN and one or more tendons. Patients' follow-up duration was a mean of 3.5 months (one to eight months). All follow-up patients showed no symptoms of a neuroma or nerve tether pain. All patients were discharged without re-referral or further surgery. Our patient sample demonstrates promising results using an adipofascial interposition flap as a prophylactic measure in traumatic injuries to reduce nerve tether pain and symptomatic neuroma formation in the SRN.