Treatment Of Mammal Injuries To The Face

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Charla Nash has been transferred to The Cleveland Clinic to receive care from the doctors who did the first US face transplant back in December 2008. Nash was injuried earlier this week in a vicious chimp attack in Stamford, Connecticut.

Her injuries are described as including extensive facial damage, including damage to her nose, jaw and eyes, along with hand injuries. Her hands have been described as looking as if they were wrecked by a machine – crushed and shredded lacerations.

About 1% of emergency department and urgent care visits each year are for mammal bite injuries / attacks. Ten to 20 people die each year from mammal bites. In 2006, more than 300,000 injuries from dog bites alone were reported to the Centers for Disease Control and Prevention.

Animal bite injuries come in many forms: lacerations, punctures, crush injuries, tears, rips, avulsions, fractures, hemorrhage, and contusions. The type and severity of the injury will depend on the location of the bite, the animal involved, and size of the patient.

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More than two-thirds of bite injuries occur in children younger than 10 years old—boys more often than girls. Children most commonly pre-sent with bite wounds to the face, neck, and head. Adults more commonly present with bites to the extremities.

The injured person needs to be examined carefully. The wounds from large mammals (like the chimp) can damage and even fracture bones. The wounds often involve injuries to blood vessels, nerves, tendons, bones, and joints.

Care involves standard wound care. Bites are tetanus-prone wounds. Most wounds can be closed primarily. A small percentage of wounds will become infected and require early suture removal.

Bite wounds that have a higher risk of infection include crush injuries, hand wounds, puncture wounds, wounds with extensive devitalized tissue, heavily contaminated wounds, and those with prolonged time from injury to treatment.

It is not expected at this time that Nash will need a face transplant. Local repair of tissue and fractures will be done first. Nerves will be repaired when possible. Skin grafts or other reconstructive procedures will be done to help her heal.

Sources
MSNBC (Chimp Attach; Patient Transfer; Face Transplant)
Assessing and Managing Mammal Bites; Emerg Med 41(1):35, 2009; Lisa D. Mills, MD, and John Lilley, MD

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