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Lessons learned from upper extremity bear-attack management and treatment
Mihail Climov MD, Tudor Crihalmeanu MS, Jack Gelman MD
West Virginia University, Division of Plastic Surgery, Ruby Memorial Hospital
2020-02-15
Presenter: Mihail Climov
Affidavit:
This work was performed by Dr. Mihail Climov
Director Name: Kerri Woddberry MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose: Demonstrate that a multidisciplinary approach can result in limb salvage with near-functional recovery after a devastating injury from a bear attack.
Methods: IRB approval was obtained to present this work. A generally healthy 22-year-old woman was airlifted to our facility with critical right upper extremity injury from a bear attack. Injuries included brachial artery transection, fractures of the radius and ulna, thumb amputation and significant skin and muscle loss. Trauma, Orthopedics, Vascular and Plastic Surgery, Infectious Disease, Pain Management, Psychiatry and Occupational Therapy were all involved in her care. She initially underwent debridement, great saphenous vein interposition grafting of the brachial artery and forearm fasciotomies. Patient required anticoagulation due to intraoperative vessel thrombosis. Subsequently, she underwent open reduction and internal fixation of her radius and ulna fractures as well as a total of seven takes back to the operating room for debridement, partial fasciotomy closure and wound vac changes. Final wound coverage was achieved with Integra followed by split-thickness skin graft. Patient was discharged after one month of stay.
Results: Patient had a long but remarkable recovery that was complicated by nutritional limitations, severe limb pain, and post-traumatic stress disorder.
Conclusions: Despite suffering an extensive loss of skin and soft tissue including loss of two-thirds of both biceps and triceps brachii muscles, she achieved a remarkable functional recovery. She has near-complete elbow, wrist and finger range of motion and has been fitted for a thumb prosthesis. She is off narcotic pain medications and continues to improve in occupational therapy.
