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.

The "hypopigmented" bitemark: a clinical and histologic appraisal.

So-called "hypopigmented" bitemark patterns, commonly seen but not limited to dark skinned individuals, can be of value in forensic investigations. The process of aging bitemarks observed on skin is controversial and without guidelines. This report analyzes tissue obtained from the site of a hypopigmented bitemark using special histochemical stains for the identification of melanin pigment, and a panel of immunohistochemical markers to aid in the aging process. Histologic evaluation clearly showed that cellular changes in the hypopigmented area were indicative of wound healing that had taken place over a period of time. This validates the hypothesis that a hypopigmented bitemark is an indication of a wound inflicted some days previously. These findings have value in forensic investigations, particularly in cases of suspected long-term physical abuse.

A systematic review of 3D scanners and computer assisted analyzes of bite marks: searching for improved analysis methods during the Covid-19 pandemic.

The global Covid-19 pandemic has forced forensic dentists to improve infection control methods. This search investigated the practical utilization of different 3D scanners to record and to analyze bite marks in the skin- and inanimate objects with this aim in mind. A systematic review of the literature using keywords like "human bite mark", "bite mark analyzes", "3D analyzes", "3D scanning", "forensic odontology", and "forensic dentistry" was performed in three scientific databases: MEDLINEOvid®, Pubmed® and Google Scholar. The initial search yielded 263 full-text articles, of which 15 were considered eligible and current within the last 10 years. 3D scanners and computer-assisted human bite mark analyzes showed potential advantages and can be effectively used in forensic odontology on skin and inanimate objects. These technologies minimize the number of people being exposed to pathogens, simplify the chain of evidence, facilitate immediate information exchange between the team members and enable the virtual presentation of the expert witnesses in a court of law.

Nasal Reconstruction: Reconstruction of a Nasal Tip, Columella and Middle Crura Defect After Human Bite with a Turn Down Flap Associated With Conchal Graft and Interpolated Melolabial Flap.

ABSTRACT: Nasal reconstruction is one of the most difficult procedures in plastic surgery due to its complex anatomy and function. A 31-year male was sent to our evaluation after an acquired nasal defect caused by a human bite 2 years before. The defect encompassed the nasal tip, columella, and both middle crura. After a detailed evaluation, the inner lining was reconstructed with a turndown flap of the released scar. In the same operative time, a shaped conchal cartilage graft was anchored to the remnants of both lateral crura and covered with a melolabial interpolated flap. Division, debulking, and final in setting of the flap was done after 5 weeks. Although simple steps were used, a good aesthetic reconstruction was achieved with minimal donor site morbidity.This case proves that a good planning is a cornerstone of a good reconstruction.

[Infections of the hand and forearm]. / Infektionen der Hand und des Unterarms.

Infections of the hand and forearm are a frequently seen surgical emergency of the hand. Patients of all age groups are affected and underlying systemic diseases are risk factors. Posttraumatic causes are the leading cause of infections. This includes cuts and stab wounds, animal and human bites but often also minor injuries. Due to the anatomical peculiarities of the hand, rapid progression of initially inconspicuous infections can occur resulting in functional limitations. If an infection is suspected, a symptom-oriented evaluation by a hand surgeon should be performed. This includes a detailed patient history, clinical examination, laboratory analyses and imaging. This is followed by the development of an individualized and interdisciplinary treatment concept with the aim of achieving the shortest possible rehabilitation period. The treatment includes surgical cleansing of the infection, accompanied by antibiotic treatment taking the expected possible spectrum of pathogens into account. Cephalosporins and aminopenicillins in combination with beta-lactamase inhibitors are the antibiotics of first choice. Follow-up treatment includes early functional exercise under the guidance of a hand therapist to minimize postinfectious restrictions in the range of motion and to enable occupational rehabilitation. In rare cases, fulminant necrotizing infections with resulting skin and soft tissue defects can occur. In these cases, secondary plastic reconstruction is usually required after cleansing of the infection.

[A human bite wound caused a severe life threatening infection]. / Een mensenbeet met desastreuze gevolgen.

Within 24 hours after a human bite trauma, a 34-year-old male patient became septic and ended up at an intensive care unit. The combination of a local damage of the skin or mucosa, aggressive micro-organisms, local host factors, and some bad luck resulted in necrotizing fasciitis for this patient. This is a very rapid progressive infection which can spread via fat tissue and the muscle fascia. The occurrence of extensive necrosis releases a lot of cytokines and acute-phase proteins, resulting in a systemic reaction. The consequential vasodilatation makes it necessary for the heart to pump harder in order to maintain the circular volume. The patient will soon become septic and hemodynamically unstable. This can also lead to multiple organ failure with potentially fatal consequences. Because necrotizing fasciitis can be caused by commensal bacteria, even young healthy patients are at risk for this invasive life threatening disease. Early recognition of the clinical manifestations can prevent a fatal outcome.

First Recognized Human Bite in the United States by the Asian Longhorned Tick, Haemaphysalis longicornis.

We present the case summary of the first human recognized to have been bitten by the Haemaphysalis longicornis tick in the United States, which occurred in New York State. Subsequent field studies confirmed that this tick was present in multiple geographic locations near the patient's residence, including on manicured lawns.

Exploring the degrees of distortion in simulated human bite marks.

The properties of the skin and the posture of the body during photographic recording are factors that cause distortion in the bite mark injury. This study aimed to explore the degree of distortion between a 'touch mark' (method 1) and a 'bite mark' (method 2) on the left upper arm at three different positions (arm relaxed; arm flexed in two different positions). A pair of dental casts with biting edges coated in ink was used to create a mark in 30 subjects (6 ♂, 24 ♀) aged 20-50 years old. Photographs were taken using a Nikon DX digital camera (D5000). The mesiodistal widths and angle of rotations of both upper right central incisor and lower right central incisor and the inter-canine distances were analysed and compared with the true measurements using Adobe Photoshop CC 2017. Statistical analysis was carried out using SPSS Statistics 22 applying a 2 (mark type) × 3 (position) repeated measures ANOVA. For all measures studied, there was a statistically significant difference between mark types and positions. In the case of bite marks, a great degree of distortion was detected, and this increased further when changing the position of the arm. The findings demonstrated that skin properties and posture influence distortion. This could lead to inaccurate measurements and misleading pattern interpretation of bite mark injuries.

HIV transmission by human bite: a case report and review of the literature-implications for post-exposure prophylaxis.

We report a case of a probable HIV-1 transmission by human bite. The analyzed data from ten previously reported  suspected or allegedly confirmed HIV transmissions revealed a deep bleeding bite wound as the primary risk factor. A high HIV plasma viral load and bleeding oral lesions are present most of the time during HIV transmission by bite. HIV post-exposure prophylaxis (PEP) should be recommended in case of a bleeding wound resulting from a bite of an HIV-infected person. PEP was missed in this presented case.

Application Status and Prospect of Bite Mark Evidence in Forensic Odontology.

ABSTRACT: Bite marks are increasingly common in violent cases such as child abuse and sex crimes. Bite marks are often the result of a suspect's attack or a victim's self-defense. Because human teeth vary in size, shape and arrangement, bite marks on objects such as skin and food are characteristic. By using this principle, forensic odontology can identify or exclude suspects by comparing actual bite marks with the teeth marks in the mouth. In this paper, the practical application of bite mark evidence, the research status and problems of bite mark analysis are briefly reviewed, and the prospect of bite mark analysis is also discussed.

Physiological effects of a spit sock.

OBJECTIVES: Healthcare providers and law enforcement utilize spit socks to prevent exposure to communicable diseases transmitted by bodily fluid projection from agitated individuals. There are cases in which death is reported due to breathing being limited by a spit sock. There are no formally published studies on their use and safety. The aim of this study was to evaluate whether wearing a spit sock causes a clinically significant impact on breathing. METHODS: Subjects sat with the spit mask over their heads for 15 min and their vital signs and ventilatory parameters were recorded after 5 min, 10 min and 15 min. Data were compared to baseline using Student's t-test with 95% confidence intervals using SPSS. RESULTS: The median age of the 15 subjects was 28 years and 53% were male. There was no significant difference between baseline and wearing the spit sock for 5, 10 or 15 min for heart rate (p = 0.250, p = 0.181, p = 0.546), oxygen saturation (p = 0.334, p = 1.00, p = 0.173), end-tidal pCO2 (p = 0.135, p = 0.384, p = 0.187), and diastolic blood pressure (p = 0.485, p = 0.508, p = 0.915). The respiratory rate was not significantly different after 5 and 10 min (p = 0.898, p = 0.583), but decreased at 15 min (p = 0.048). The systolic blood pressure was lower after 5 and 10 min (p = 0.028, p = 0.045), but not significantly different at 15 min (p = 0.146). No subject indicated distress nor did the study need to be terminated due to pre-determined concerning vital signs or ventilatory parameters. CONCLUSIONS: In healthy subjects there were no clinically significant changes in the physiologic parameters of breathing while wearing a spit sock.

[Animal and human bites†: what to do and what to know†?] / Morsures animales et humaines†: que faire et à quoi penser†?

Animal and human bites are a common cause of admission to the emergency room and the infections are common, although they are often trivialized. Complications can range from simple cellulitis to septic shock especially in asplenic patients with Capnoyctophaga canimorsus infection. Other less common infections are possible such as rat-bite fever, leptospirosis, tularemia, and evaluation of post-exposure prophylaxis (anti-tetanus, anti-rabies, HIV, HBV) is essential. Antibiotic prophylaxis remains controversial but is recommended for certain groups of patients and must cover common bite pathogens.

Les morsures animales et humaines sont un motif fréquent d'admission aux urgences et leur infection est fréquente, alors qu'elles sont souvent banalisées. Les complications peuvent aller d'une simple dermohypodermite au choc septique, notamment chez les patients aspléniques lors d'infection à Capnocytophaga canimorsus. D'autres infections moins communes sont possibles comme la «â€…rat-bite fever ¼, la leptospirose, la tularémie, et l'évaluation des prophylaxies postexpositionnelles (antitétanique, antirabique ; VIH, VHB en cas de morsures humaines) est primordiale. L'antibioprophylaxie reste controversée, mais est recommandée pour certains groupes de patients, et se doit de couvrir les germes retrouvés fréquemment lors de morsures.

A Human Bite on the Scrotum: Case Report and Review of Management in the Emergency Department.

BACKGROUND: Human bites involving the genitalia rarely present to the emergency department (ED). They have the potential to cause life-threatening secondary infections as well as serious physical and functional damage. CASE REPORT: We report a case of an adult male who sustained a human bite to the scrotum, resulting in a ragged laceration on the anterior scrotum, with a devascularized flap and necrotic edges overlying the wound. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Human bites to the scrotum are rare and, hence, the experience of emergency physicians treating patients presenting with these injuries may be minimal. This puts patients at risk of underevaluation or suboptimal treatment. The rapid initiation of antibiotics in the ED and thorough wound debridement will prevent infections, aid healing, and lead to improved outcomes by preserving organ function and integrity. We therefore present a systematic approach to the management of patients with human bite to the scrotum in the ED.

Epidermis and Enamel: Insights Into Gnawing Criticisms of Human Bitemark Evidence.

Critics describe forensic dentists' management of bitemark evidence as junk science with poor sensitivity and specificity and state that linkages to a biter are unfounded. Those vocal critics, supported by certain media, characterize odontologists' previous errors as egregious and petition government agencies to render bitemark evidence inadmissible. Odontologists acknowledge that some practitioners have made past mistakes. However, it does not logically follow that the errors of a few identify a systemic failure of bitemark analysis. Scrutiny of the contentious cases shows that most occurred 20 to 40 years ago. Since then, research has been ongoing and more conservative guidelines, standards, and terminology have been adopted so that past errors are no longer reflective of current safeguards. The authors recommend a comprehensive root analysis of problem cases to be used to determine all the factors that contributed to those previous problems. The legal community also shares responsibility for some of the past erroneous convictions. Currently, most proffered bitemark cases referred to odontologists do not reach courts because those forensic dentists dismiss them as unacceptable or insufficient for analysis. Most bitemark evidence cases have been properly managed by odontologists. Bitemark evidence and testimony remain relevant and have made significant contributions in the justice system.

Analysis of Intercanine Distance and Dimensional Changes in Bite Marks on Foodstuffs Using Cone Beam Computed Tomography.

Bite marks on foodstuff at the crime scene provide a 3-dimensional imprint of the suspect's dentition. The bite mark analysis can provide useful evidences, leading to the inclusion or exclusion of the individual under investigation. This study was designed to assess bite marks on various common foodstuffs (chocolate, apple, chewing gum, cheese) for different time intervals using cone beam computed tomography (CBCT) to evaluate the dimensional changes in the foodstuffs. Analysis of variance test was used to compare the bite marks measured using CBCT in maxillary and mandibular arches with significance set at P < 0.05. The results show that teeth can transfer their characteristics to the bitten foodstuffs. The highest accuracy for comparative bite mark analysis was observed in chocolate followed by cheese, chewing gum, and apple. The CBCT-assisted analysis of bite marks is a nondestructive, accurate, and efficient method. The CBCT documentation has no distortion artifacts, and subsequent analysis in 3-dimensional space is possible.

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.

Bite injuries caused by transcranial electrical stimulation motor-evoked potentials' monitoring: incidence, associated factors, and clinical course.

PURPOSE: The incidence of bite injuries associated with transcranial electrical stimulation motor-evoked potentials monitoring reportedly ranges from 0.13 to 0.19%. However, in clinical practice, bite injuries appear to occur more frequently than previously reported. Our aim was to identify the incidence of and perioperative risk factors associated with bite injuries caused by transcranial electrical stimulation motor-evoked potential monitoring. METHODS: Patients who underwent elective surgery with transcranial electrical stimulation motor-evoked potential monitoring at a single tertiary hospital in Japan between June 2017 and December 2017 were included in this study. All patients were assessed by oral surgeons preoperatively and postoperatively. The associated factors with bite injuries were explored by the univariate analysis. RESULTS: 12 of 186 patients experienced 13 bite injuries, including three lip, six oral mucosa, and four tongue injuries. No patient required suture repair. 11 of 12 patients had uneventful postoperative courses and were cured within 12 postoperative days. One patient with a tongue ulcer and a hematoma had difficulty in oral intake and persistent dysgeusia. Patient severe movement during transcranial electrical stimulation motor-evoked potential monitoring was associated with bite injuries (p = 0.03). CONCLUSIONS: The incidence of bite injuries assessed by oral surgeons was 6.5% in patients with transcranial electrical stimulation motor-evoked potential monitoring, and the patients with severe movement during the monitoring tended to incur bite injuries. In rare cases, transcranial electrical stimulation motor-evoked potential monitoring may cause difficulty in oral intake and dysgeusia.

Human and Animal Bites.

In the United States, nearly 56% of households owned a pet in 2011 according to the 2012 U.S. Pet Ownership & Demographics Sourcebook by the American Veterinary Medical Association. The survey also reports that approximately 70 million dogs and 74 million cats lived in households in the United States during the same year. (1)Human and animal bites are a frequent cause of primary care and emergency department visits for children. It is estimated that 250,000 human bites, 400,000 cat bites, and 4.5 million dog bites occur in the United States each year in both adults and children. (2) In the United States, approximately 10% of all human bites will become infected in a child with a bite wound. The infection rate of dog bites in children is 20%. Cat bite infection rates in children vary but can be up to 50%. Each type of bite wound has a predisposition for sex and/or age. Infected bite wounds manifest with swelling, erythema, and tenderness with or without drainage of the affected site and can lead to serious complications. Most animal bite wounds are polymicrobial in nature. Pasteurella species (spp.) is the most common organism isolated from both cat and dog bites. The microbiology of human bites consists of both aerobic and anaerobic bacteria.Basic medical management of bite wounds includes thorough cleansing and debridement. Irrigation, closure, and need to obtain culture depend on the type of bite wound, the appearance of the wound, the and timing of medical evaluation after the initial injury. Amoxicillin-clavulanate is the antibiotic of choice for prophylaxis and empirical therapy for children who are not allergic to penicillin. With most animal bites being preventable injuries, healthcare providers caring for children have an important role discussing pet safety with the child and the family.

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.

An analysis of dental intercanine distance for use in court cases involving bite marks.

High levels of crime in South Africa and the resulting court cases requiring bite mark evidence have necessitated continuous research into the prevalence and interrelationship of recognisable dental features present in bite marks. This study represents the largest data set of descriptive statistics related to intercanine distance, in which the means, standard deviations, medians and interquartile ranges across four racial groups were determined. Intercanine distances were also statistically weighted by determining the common, uncommon and very uncommon values for each of the racial groups. The results of this research show that we can consider any maxillary intercanine distance more than 24.1 mm and less than 43.0 mm to represent a human bite mark. Black males had the largest mean (average) intercanine distance of 36.33 mm (standard deviation 2.49 mm) and white females the smallest mean intercanine distance of 33.4 mm (standard deviation 2.13 mm). The analyses showed statistically significant differences between the mean intercanine distances of different race and gender groupings. The authors do not advocate trying to determine the race or gender from intercanine distances determined, but rather the relevance of the intercanine distances in the specific race and gender groupings. This study makes a meaningful scientific contribution to the presentation of bite mark evidence at a time when subjective opinions need to be replaced with scientific data.