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Management of Complex Injuries to the Upper Extremity Secondary to Wild Animal Attacks: A Case Report and Review of the Literature
Dylan Anderson, BS,1 Tudor Crihălmeanu, MHS,1 Mihail Climov, MD,2 Jack Gelman, MD, FACS2
1 West Virginia University School of Medicine, Morgantown, West Virginia, USA
2 West Virginia University Department of Surgery, Morgantown, West Virginia, USA
West Virginia University
2021-02-15
Presenter: Dylan Anderson, BS
Affidavit:
This project entirely represents the original work of the resident.
Director Name: Kerri Woodberry, MD, MBA, FACS
Author Category: Medical Student
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Patients who sustain wild animal related injuries often present with complex injuries. The injuries are unique because of the combination of forces: cutting, penetrating, crushing, tearing, falling, and blunt force. The polymicrobial environment carried by wild animals can introduce local or systemic infection, leading to severe morbidity and mortality. We performed a literature review on PubMed using the guidelines for Preferred Reporting Items for Systematic Reviews. Eighty articles were identified and vetted using title and abstract review. We excluded articles in which the victims were animals, articles involving domesticated animals, non-mammals, or other non-pertinent studies, culling the articles to 54, mostly case reports and systematic reviews. The top three animals in these attacks were bears, tigers, and leopards. A few cases described fatal attacks by a giant anteater, an elephant, otter, and a capybara. Of the 207 documented cases of bear attacks, 37 were fatal. Most patients died at the scene. Five of the 170 non-fatal injuries presented with significant upper extremity injury. Most patients were treated with antibiotics, serial debridements, tetanus, rabies prophylaxis, and reconstruction by vascular, orthopedic, and plastic surgery. We present a case of a 22-year-old female with near-functional recovery after an attack to her right upper extremity by a Himalayan bear. Injuries included brachial artery transection, fractures of the radius and ulna, thumb amputation, and significant skin and muscle loss. We recommend a multidisciplinary team approach to treat patients including trauma, vascular, orthopedic, and plastic surgery, infectious disease and psychiatry to attain a reasonable functional recovery.
