Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Human Bites Over Nose: Management and Reconstruction

  • Kuldeep Singh (Department of Burns and Plastic Surgery, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS)) ;
  • Krittika Aggarwal (Department of Burns and Plastic Surgery, Lok Nayak Hospital)
  • Received : 2022.04.05
  • Accepted : 2022.10.27
  • Published : 2023.03.15
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Abstract

Background Human bite wounds in emergency department need evaluation in regard of reconstruction. These are due to occlusive bite injuries over face. Most commonly, human bites over face involve ear and nose, and may lead to avulsion injury. Defects over nose can be reconstructed immediately after debridement or delayed till the wound heals and scar becomes supple. Thorough wash and lavage with broadspectrum antibiotic cover has utmost importance in preventing cartilage infection. Methods We report 20 cases of human bite injuries over nose who presented to us in emergency department between 2018 and 2020. At the time of presentation the wound was assessed for closure. If not possible, patient was planned for delayed reconstruction after 3 months. In case delayed reconstruction was planned, the skin and nasal mucosa were approximated at first presentation. The patients underwent paramedian forehead flap after recreation of defect with conchal cartilage graft. Second stage of flap detachment and insetting was done after 3 weeks. After three weeks of second stage, third stage of flap thinning was done. Patients were followed for 3-6 months and subjective satisfaction was noted. Results Nineteen patients underwent delayed staged reconstruction with paramedian forehead flap and one underwent primary wound closure. The flap survival was 100%. The patient satisfaction was excellent in most cases. Conclusion We recommend delayed reconstruction for human bite nasal injuries. For reconstruction, paramedian forehead flap with conchal cartilage graft, if required, provides excellent reconstructive option with good contour and color match and minimal donor site scar.

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References

  1. Ng D, Chan T, Pothiawala S. A human bite on the scrotum: case report and review of management in the emergency department. J Emerg Med 2018;54(04):537-539 https://doi.org/10.1016/j.jemermed.2017.12.039
  2. Stefanopoulos PK, Tarantzopoulou AD. Management of facial bite wounds. Dent Clin North Am 2009;53(04):691-705, vi https://doi.org/10.1016/j.cden.2009.08.005
  3. Henry FP, Purcell EM, Eadie PA. The human bite injury: a clinical audit and discussion regarding the management of this alcohol fuelled phenomenon. Emerg Med J 2007;24(07):455-458 https://doi.org/10.1136/emj.2006.045054
  4. Tomasetti BJ, Walker L, Gormley MB, Berger J, Gold BD. Human bites of the face. J Oral Surg 1979;37(08):565-568
  5. Austin GK, Shockley WW. Reconstruction of nasal defects: contemporary approaches. Curr Opin Otolaryngol Head Neck Surg 2016;24(05):453-460 https://doi.org/10.1097/MOO.0000000000000295
  6. Fudem GM, Montilla RD, Vaughn CJ. Single-stage forehead flap in nasal reconstruction. Ann Plast Surg 2010;64(05):645-648 https://doi.org/10.1097/SAP.0b013e3181c925fc
  7. Hsiao YC, Chang CS, Zelken J. Aesthetic refinements in forehead flap reconstruction of the Asian nose. Plast Surg (Oakv) 2017;25(02):71-77 https://doi.org/10.1177/2292550317694853
  8. Weng R, Li Q, Gu B, Liu K, Shen G, Xie F. Extended forehead skin expansion and single-stage nasal subunit plasty for nasal reconstruction. Plast Reconstr Surg 2010;125(04):1119-1128 https://doi.org/10.1097/PRS.0b013e3181d0acb1
  9. Fan J. A new technique of scarless expanded forehead flap for reconstructive surgery. Plast Reconstr Surg 2000;106(04):777-785 https://doi.org/10.1097/00006534-200009020-00004
  10. Kheradmand AA, Garajei A, Motamedi MH. Nasal reconstruction: experience using tissue expansion and forehead flap. J Oral Maxillofac Surg 2011;69(05):1478-1484 https://doi.org/10.1016/j.joms.2010.07.031
  11. Talan DA, Abrahamian FM, Moran GJ, Citron DM, Tan JO, Goldstein EJEmergency Medicine Human Bite Infection Study Group. Clinical presentation and bacteriologic analysis of infected human bites in patients presenting to emergency departments. Clin Infect Dis 2003;37(11):1481-1489 https://doi.org/10.1086/379331
  12. Maniscalco K, Edens MA. Human Bites. In: StatPearls. Treasure Island, FL: StatPearls Publishing; July 19, 2020. PMID 28613515
  13. Aloua R, Kerdoud O, Kaouani A, Iro S, Slimani F. Restorative management of human bite injuries to the face: case series. Ann Med Surg (Lond) 2021;62:249-252 https://doi.org/10.1016/j.amsu.2021.01.045
  14. Ollapallil JJ, Beaso J, Watters DA. Human bite injuries to the nose. Trop Doct 1995;25(02):85-87 https://doi.org/10.1177/004947559502500213
  15. Stathopoulos P, Ameerally P. Reconstructing the nasal tip after a human bite: a challenge for the reconstructive surgeon. J Maxillofac Oral Surg 2020;19(01):17-20 https://doi.org/10.1007/s12663-019-01226-9
  16. Earley MJ, Bardsley AF. Human bites: a review. Br J Plast Surg 1984;37(04):458-462 https://doi.org/10.1016/0007-1226(84)90130-9
  17. Olaitan PB, Uduezue AO, Ugwueze GC, Ogbonnaya IS, Achebe UJ. Management of human bites of the face in Enugu, Nigeria. Afr Health Sci 2007;7(01):50-54