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.

Chondro-Cutaneous Autograft for Reconstruction of the Nasal Ala After a Human Bite.

BACKGROUND The nasal ala is a paired structural subunit of the nose that is functionally important in the maintenance of the nasal valve. It consists of 3 anatomically distinct layers: skin, cartilage, and mucosa, all of which need to be restored in reconstructive surgeries to maintain nasal patency. When multiple layers are involved in a defect, the reconstruction requires combining procedures to replace each layer. CASE REPORT We describe a peculiar case of a 58-year-old man with a full-thickness loss of substance of the right nasal ala due to a human bite. The patient came to our hospital after an altercation with another man who bit his nose off. He was initially seen at a smaller regional hospital that did not have a plastic surgery department and was soon after transferred to our facility due to the complexity of the case. To reduce the risk of infection, the patient was treated with a complete course of intravenous antibiotic therapy and the wound was medicated daily with antiseptic solutions. The loss of substance was reconstructed with a composed graft from the auricle concha and the melolabial flap. CONCLUSIONS Defects of the nasal ala are challenging to reconstruct, given its complex 3-dimensional structure. The successful repair of these defects provides aesthetic symmetry and preserves nasal function. A wide variety of reconstructive options have been utilized in many nasal reconstruction cases and have been documented. The combination of a chondro-cutaneous graft from the auricular concha and a melolabial flap graft allowed a good result without local or systemic complications.

Predicting Amputation and Multiple Debridements in Tooth Knuckle Injuries.

BACKGROUND: Tooth knuckle injuries can be expensive to treat and may necessitate amputation in some cases. Several limitations exist in the literature regarding our knowledge around the factors predicting amputation and the need for multiple debridements in treating this injury. METHODS: A historic cohort study of 321 patients treated for tooth knuckle injuries was undertaken. Twenty-one demographic, clinical and laboratory variables were collected. Two outcome measurements were collected - the need for amputation and the need for more than one surgical debridement. A multivariate logistic regression was performed to determine the relationship between the predictor variables and the outcome measurements. RESULTS: Of the 321 patients examined, 1.6% required amputations and 25% required multiple debridements. Osteomyelitis was found to be a major predictor for amputation in these patients (OR = 35). Delayed presentation (OR = 1.1) and diabetes (OR = 2.6) were found to significantly increase the risk of requiring multiple debridements. CONCLUSIONS: Our models were able to predict what patients were at the greatest risk for amputation and multiple debridement. Reducing rates of osteomyelitis and delays in presentation may help reduce the incidence of amputation and reoperation in this injury.

Microvascular Replantation of the Avulsed Lip.

Traumatic facial soft tissue injury often creates both aesthetic and functional deficits. In complete lip avulsions, microvascular replantation is a reconstructive option that has the potential to fulfill both of these goals. However, lip replantations remain rare and there are few reports in the literature. The authors aim to present a clinical report of a young male who sustained a human bite injury and underwent microvascular replantation of a completely avulsed lower lip and to review the literature and management of these complex injuries.

Therapeutic and Reconstructive Approach of Lower Lip Amputation After Human Bite: Case Report.

In this article, we describe the case of a patient suffering from labial avulsion after a human bite, initially treated with direct closure and reconstructed surgically later on. Also, a brief summary of existent recommendations in scientific literature about the management of bite wounds is provided.

Human bite injuries to the head and neck: current trends and management protocols in England and Wales.

INTRODUCTION: Human bite injuries can be challenging in their presentation to the examining physician. In a study by Merchant et al., 18% of patients presenting with a human bite injury had suffered wounds to the head and neck region. Current trends in their initial management at presentation to emergency departments throughout England and Wales will be discussed in this paper. MATERIALS AND METHOD: A postal survey was sent out to 100 A&E lead clinicians. This was followed up by telephone enquiries to improve the response rate. The collated results of the survey were entered onto a spreadsheet (Microsoft Excel©) for the purpose of statistical review. RESULTS: A 68% response rate from A&E departments throughout England and Wales demonstrated a lack of consensus in the initial management and subsequent treatment of human bite injuries. Written protocols are in place for human bite injuries in 54.4% of units. In 100% of units, initial management involves irrigation +/- debridement of the wound, though there is a lack of agreement on the surgical management of the wound. 77.9% of units follow 'needle stick protocols' when stratifying risk for blood-borne viruses. CONCLUSION: Human bites pose a number of unique problems, ranging from cellulitis to the transmission of communicable diseases. The maxillofacial surgeon has the added dilemmas surrounding subsequent repair and reconstruction. Appreciation of the complexity of human bite injuries will ensure optimal care for the patient. We propose a set of guidelines developed 'in-house' to assist in the management of human bite injuries.

Animal and human bite injuries: a 5-year retrospective study in a large urban public hospital in Venezuela.

INTRODUCTION: Animal bite injuries to the head and neck regions are an important public health problem. Most of these bites are from dogs. A 10-year retrospective study was undertaken to determine the prevalence of animal and human bites. MATERIALS AND METHODS: This retrospective study was done from January 2011 to December 2016 and included 387 patients with a mean age of 21.51 years. Data collection included age, sex, days of hospitalization, lesion type, and clinical management. RESULTS: Majority of patients were in age group of 21-29 years, followed by 31-55 years. Out of the total 281 patients, 42 patients (51.60%) were males and 34 patients (48.40%) were females. Mean hospital stay was 7.2 days with a minimum of 5 days and a maximum of 12 days. Surgical management included cleansing and primary closure of the wound. CONCLUSIONS: We concluded that the use of empiric antibiotic prophylaxis is essential for management of facial animal bite, and the antibiotic of first choice is amoxicillin-clavulanic acid. The aim of immediate surgical repair (< 6 h) is to avoid infections. The persistence of dog bite is public health problem in Venezuela.

Auricular reconstruction after human bite amputation using the Baudet technique.

OBJECTIVE: This study aimed to present a case of a successful re-implantation of an amputated auricle following a human bite using the Baudet technique. METHODS: Case report and review of the literature. RESULTS: The patient had a very satisfactory postoperative result in terms of appearance and function of the reattached auricle. Cartilage loss was minimal. CONCLUSION: Reattachment of an amputated auricle as a composite graft following a traumatic human bite is feasible. The Baudet technique is a simple alternative that avoids the complexity of microsurgical anastomosis while improving upon the high failure rate associated with simple reattachment.

Pattern of presentation and management of lip injuries in a Nigerian hospital.

AIM: Human lip injuries, although uncommon, present major challenges in terms of reconstructive options and the outcome of surgical management. The reconstructive techniques are usually varied but the ultimate objectives of treatment are to achieve healing, function, and aesthetics. The aim of this study was to report the etiology, pattern of presentation, and surgical management of lip injuries in Lagos University Teaching Hospital (LUTH). MATERIALS AND METHODS: A prospective study of consecutive cases of lip injury was conducted at the Oral and Maxillofacial Surgery Clinic of the Lagos University Teaching Hospital. Data collected included age and sex of patients, etiology, pattern of presentation, and surgical techniques of repair. RESULTS: A total of 13 patients with lip injury to the lip were included in the study (M = 6, F = 7). Human bite (11 cases) was the most common cause of injury followed by electric burns (2 cases). The most (81.8%) frequently affected site was the lower lip. Most patients presented within 72 hours after injury with infected wound. Treatment offered included thorough debridement and primary repair using various surgical techniques. A one-stage surgical technique was employed in all cases. Healing was uneventful in all cases and satisfactory. CONCLUSION: Most of the lip injuries in the present study were due to human bites with almost equal sex distribution. Lower lip was most commonly affected. All cases were successfully treated by debridement, broad spectrum antibiotic coverage, and one-stage surgical repair with a favorable 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.

Ear replantation after human bite avulsion injury.

Traumatic auricular amputation due to human bite is not a common event, but it constitutes a difficult challenge for the reconstructive surgeon. Microsurgery can be performed in some cases, but replantation of a severed ear without microsurgery can be a safe alternative. We present a case of a 44-year-old male individual who was involved in a fight and sustained a human bite, resulting in almost a complete amputation of his right ear. The Baudet technique has been used successfully. It is a simple technique and very reliable because it allows a great surface of contact between the graft and the vascular bed, substantially increasing its odds of survival in cases presenting with high risk of infection such as human bite injury. It also produces excellent aesthetic results.

Reconstruction following traumatic partial amputation of the ear.

BACKGROUND: Reconstruction following traumatic amputation of the external ear remains a unique challenge to the plastic surgeon. The authors report a series of ear reconstructions with autologous costal cartilage in patients following traumatic partial amputation of the ear. Technical points regarding the carving of the cartilage framework and methods of skin coverage are discussed. METHODS: Fifty partial ear reconstructions with autologous costal cartilage were performed over a 4-year period. All patients had suffered previous traumatic amputation of part of the external auricle due to bite injuries (n = 36), road traffic accidents (n = 6), burns (n = 5), or torture (n = 3). A two-stage technique of reconstruction with autologous cartilage graft was used based on Nagata's adaptations of Brent's original technique. In nine cases, skin shortage or extensive scarring required preoperative tissue expansion (n = 4) or a temporoparietal fascial flap (n = 5) to provide adequate coverage of the cartilage framework. RESULTS: Forty-seven patients had a successful surgical outcome without complication. Two patients developed small areas of skin necrosis resulting in exposure of the cartilage framework. These healed with conservative management with minor loss of definition. One case of wound infection resulted in significant loss of definition of the construct, which required a further surgical procedure with additional costal cartilage graft. CONCLUSION: Reconstruction of the external ear with autologous costal cartilage following traumatic amputation can produce high-quality auricles consistently and is becoming the treatment of choice for such injuries, given access to a specialist center with exposure to a high volume of cases.

Presentation and management of human lip bites at a Kenyan center: a case series.

PURPOSE: To describe the pattern of presentation and management of human lip bites. PATIENTS AND METHODS: Data on patients who presented with human lip bites between 2005 and 2007 were recorded. RESULTS: There were 6 men and 4 women whose ages ranged from 25 to 60 years with varying degrees of lip loss that occurred in different circumstances. Reconstruction using local flaps was carried out in various stages to achieve satisfactory esthetic and functional outcomes. CONCLUSIONS: Human lip bites can be repaired at any time of presentation using local flaps with acceptable results. Wound infection is not a major issue following these injuries.

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.

Use of linked mucosal flap for lower lip reconstruction after human bite injury.

AIM: An alternative method of reconstruction of a lower lip defect is presented, using a mucosal flap taken from the upper lip. This approach leaves the skin intact and therefore avoids skin scarring, with its associated unpredictable healing. The upper lip mucosal flap applied to reconstruct the lower lip injury was identical to the injured tissue type. RESULT: The results were functionally and aesthetically excellent (as illustrated). CONCLUSION: This technique represents an excellent alternative to reconstruction of a damaged lip, with the benefits of minimal scar tissue formation and excellent aesthetic result.

Management of human bites of the face in Enugu, Nigeria.

BACKGROUND: Human bites of the face present to the surgeon sometimes with a dilemma as to the method and timing of surgery. Often patients present with soft tissue defects as a result of the injury sustained. Reconstruction therefore becomes absolutely necessary to avoid psychosocial complications. OBJECTIVES: The aim of this paper is to review human bites of the face, which presented to the Plastic Surgery Department of the National Orthopaedic Hospital, Enugu, Nigeria over a 10-year period and highlight the epidemiology, presentation, management and its outcome. METHODS: A retrospective review of the cases of human bites of the face that presented within a ten year period was carried out. Sources of information were the case notes and operation registers. Information obtained includes age, gender of the patients as well as that of the assailants and the relationship of the assailants to the patients. Sites of the injuries, management and outcome were also obtained. RESULTS: There were 54 patients seen and treated during the period with the age range 16-54 years (Mean age, 33.8+/-2.3). The male to female ratio was 1:1.6. Various surgical procedures including wedge excision and direct closure (for the lip); midline forehead flap cover, composite auricular graft and nasolabial flaps (for the nose) were carried out. Three of the 9 noses bitten were skin grafted and 3 had primary direct closure. Few complications occurred. CONCLUSION: We conclude that human bites still remain common in our environment. These sometimes need reconstruction due to loss of parts. Minimal debridement with primary closure/reconstruction of human bites of the face; when presented early, gives a good result.