Shark-Related Injuries in the United States: A National Trauma Data Bank Analysis.

BACKGROUND: Shark-related injuries (SRIs) are a dreaded, but rare, source of injury that have not been well described. The present study aims to examine the incidence, injuries, and outcomes of SRIs presenting to US trauma centers. STUDY DESIGN: The National Trauma Data Bank was queried from 2015 to 2018 to identify SRIs using ICD-10 e-codes W56.41XA, W56.42XA, and W56.49XA. Descriptive analyses were conducted on patient demographics, injuries, hospital course, procedures, and outcomes. RESULTS: Fifty-three patients were identified with a mechanism of injury that was shark-related. The median age was 29 years (range: 3-67) and median injury severity score was 5 (IQR: 3-10). The majority of patients (96%) were admitted to the hospital (median length of stay (LOS): 4.0 days, IQR: 3.0-8.0), 55% went directly to the operating room, and 53% required intensive care unit (ICU) admission (median ICU LOS: 4.5 days, IQR: 1.3-7.0). Extremity injuries were common: 47% suffered lower extremity injuries, 40% had upper extremity injuries, and 13% had both. The majority of patients underwent surgical procedures: 83% had soft tissue injuries requiring debridement, flap coverage, or skin grafting; 28% suffered neurovascular injuries (17% requiring nerve repair and 2% requiring arterial bypass); and 59% required orthopedic intervention. Six patients (11%) required amputation(s). All patients survived to discharge. CONCLUSION: Although an exceedingly rare source of trauma, SRIs are frequently associated with devastating injuries. Given the severity of injuries and associated procedures required, these patients warrant referral to a trauma center capable of providing comprehensive care.

Successful microsurgical revascularization of an almost totally amputated ear lobe by horse bite.

Total or subtotal amputation of the external ear related to horse bite is an uncommon situation. In our case, we report successful microsurgical revascularization of almost totally amputated ear of a 75-year-old male patient caused by a horse bite.

Moxifloxacin in complicated skin and skin structure infections (cSSSIs): A prospective, international, non-interventional, observational study.

INTRODUCTION: ARTOS was an international, prospective, non-interventional, non-controlled observational study designed to determine the effectiveness, safety, and tolerability of moxifloxacin under daily-life conditions in patients with complicated skin and skin structure infections (cSSSIs) treated in Europe, the Middle East, and Asia-Pacific region. METHODS: Eligible patients included males and females who were hospitalized patients or outpatients requiring antibiotic therapy for cSSSIs and for whom the treating physician had elected to begin moxifloxacin therapy in accordance with its approved indications. Patients were assessed before therapy and then at one or two follow-up visits. Effectiveness was assessed with respect to improvement and resolution of signs and symptoms of cSSSIs and safety with respect to the nature and frequency of adverse events and adverse drug reactions. RESULTS: A total of 6,594 patients were enrolled of whom 5,444 had data available for analysis; 4,692 patients received sequential intravenous/oral (IV/PO) moxifloxacin and 752 exclusively IV therapy. A majority of patients were aged between 40 and 79 years and had one or more comorbid conditions. Post-surgical wound infection, skin abscess, and diabetic foot infection were the cSSSIs most frequently diagnosed and treated with moxifloxacin, with almost 90% of infections rated moderate or severe. Treating physicians chose sequential moxifloxacin 400 mg for most patients, switching from IV to PO after 3-4 days. On average, treatment was maintained for 10 days. Treatment with moxifloxacin was associated with rapid relief in symptoms, with 93.2% of patients experiencing either complete resolution of symptoms or improvement at follow-up. Moxifloxacin was well tolerated with adverse drug reactions occurring in only 2% of patients. CONCLUSIONS: This study, conducted in a 'real-world' setting, confirms the effectiveness and safety of moxifloxacin in the treatment of a wide spectrum of cSSSIs seen in routine clinical practice.

Coadjuvant treatment with surgery and pirfenidone in severe facial trauma due to dog bite.

BACKGROUND: This case report assesses the effectiveness of surgery plus pirfenidone (PFD) as a concomitant therapy in the management of facial trauma after severe dog bite. METHODS: A 16-month-old female patient who suffered a severe attack by a big-sized dog (Rottweiler) in the midface area was managed with surgery/PFD combination and followed up for 20 months to evaluate the efficacy to control, prevent, and improve injury sequels. RESULTS: Surgery/PFD combination offered a good complementary therapy downregulating inflammatory activity, improving blood supply, and activating cytokine modulation and collagen synthesis/biosynthesis (scar control). No side effects were reported in this case report. CONCLUSIONS: Surgery/PFD management for severe facial dog bites represents a safe and effective therapeutic option to protect and improve a patient's quality of life, minimizing long-time sequels.

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.

Lip replantation and delayed inset after a dog bite: a case report and literature review.

Dog bites to the face are common in children and often involve amputation of the lip or cheek resulting in a devastating facial injury. When feasible, replantation of the amputated lip segment provides the optimal cosmetic outcome. Here, we present the case of a partial upper lip replantation with delayed inset as a new treatment option. Revascularization of the central upper lip segment was enabled by anastomosis to a single labial artery. Inset compression at the time of initial closure caused arterial insufficiency. Therefore, a delayed, sequential inset was performed over the following 2 weeks resulting in an esthetically and functionally successful replantation. A comprehensive review of the literature on published lip replantation techniques is also provided and discussed. We add delayed inset to the armamentarium of the microsurgeon when faced with these difficult injuries.

Jellyfish sting injury to the cornea.

A 25-year-old woman presented to the emergency room 2 hours after a jellyfish sting to the left eye. Centrally located linear epithelial defects were observed on slit-lamp evaluation. The epithelial defects improved but did not heal totally after meticulous patching with antibiotic ointment and cycloplegic drops. Small, subepithelial negative staining areas within the epithelial defects were observed on day 3. Confocal microscopy was performed and revealed thread-like hyperreflective structures, mainly located at the basal epithelial layer. Following debridement of the traumatized areas, the corneal epithelium healed completely in 24 hours, resulting in increased visual acuity and decreased foreign body sensation. Jellyfish stings to the eye may involve the intrusion of the nematocysts, thread-like venomous structures, into the cornea. Debridement of these foreign bodies can be helpful in the treatment of resistant cases.

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.

The fate of an amputated nose after replantation.

Traumatic amputation of the nose is a challenging management problem. We describe the case of a 69-year-old woman who had a dog-bite nasal amputation. The avulsed piece, including the lobule, and approximately half of the columella and alae, was replanted within 2 hours of the trauma. Hyperbaric oxygen therapy was administered for 12 daily sessions. Skin gradually necrosed, and the eschar was tangentially excised. Almost all of the mucosa and of the cartilage layers survived and the final defect was smaller than the original. A 3-stage repair was performed by a paramedian forehead flap to replace cover. Lining was by approximation of native tissues, whereas framework was reinforced by conchal and septal cartilage grafts. The outcome was functionally and aesthetically satisfactory. Our case confirms that replantation of an amputated nose as a composite graft is worthwhile. Although the skin necrosed and required reconstruction, most of the lining and of the cartilage support survived, greatly improving the ease of reconstruction, as well as nasal function.

[Surgical therapy for hand infections. Part I]. / Chirurgische Therapie von Infektionen der Hand--Teil I.

Due to its function, anatomy, and exposition to multiple pathogens, the hand is highly susceptible to infection. Most of these infections are post-traumatic. Isolates of pathogens from infected hands contain mainly Staphylococcus aureus and beta-hemolytic group A streptococci. We find Pasteurella canis and P. multocida from cat and dog bite wounds and Eikenella corrodens from human bite wounds. The "fight-bite clenched fist" wound, with penetration of the metacarpophalangeal joint and its high risk of septic arthritis, has always to be suspected when patients present with human bites. The therapy of hand infection is based on three principles: surgical treatment, adequate antimicrobial therapy, and early physiotherapy. Early infectious conditions of the hand, e.g. cellulitis and early paronychia, may be treated without surgery. Antimicrobial treatment must be specific for the pathogen and its resistance to antimicrobial agents. Bite wounds should be treated with beta-lactam antibiotics and beta-lactamase inhibitors. Staphylococci and streptococci can be covered by first and second generation cephalosporins. The increasing resistance of staphylococci to antibiotics has to be taken into account. Infections with anaerobic and gas-producing bacteria are rare but occur predominantly in diabetics and immune-compromised individuals.

Hyperbaric oxygen therapy in the treatment of soft tissue necrosis resulting from a stingray puncture.

Necrotizing soft tissue processes of the foot secondary to an acute stingray envenomation can be a challenge to manage. Very little is reported in the orthopaedic literature to aid the practicing surgeon faced with this problem. In this case report, we describe the wound management and team approach employed in this patient's care, including the indications for hyperbaric oxygen therapy, which, in this case, was ultimately successful.

Composite grafting and hyperbaric oxygen therapy in pediatric nasal tip reconstruction after avulsive dog-bite injury.

It is estimated that more than four million people are bitten by dogs in the United States each year. The majority of such injuries are minor, and their treatment does not usually require surgical consultation. However, the authors report a case in which a Rottweiler inflicted a mutilating nasal tip/alar rim avulsion on a 5-year-old boy. They report their experience with immediate reconstruction of the nasal defect using a large ipsilateral auricular cartilage composite graft (crus helix). Adjunctive hyperbaric oxygen therapy (without sedation or anesthesia) was used to maximize the stimulus for graft revascularization. Reconstructive goals were achieved while avoiding the need for a central facial donor site defect.

The sea, stingers, and surgeons: the surgeon's role in prevention, first aid, and management of marine envenomations.

Marine envenomations are the statistical price that humankind pays for intruding into the aquatic domain. Individual risk can be reduced by knowledge and prudence. If envenomations do occur, lives can be saved, complications prevented, and convalescence facilitated by knowledge of and interest in these fascinating creatures of the sea.