[hermantheshocker]

India. A 46-year-old man presented to the casualty department after being attacked by a Himalayan black bear. On the day of the attack at approximately 12 noon, he was working in a grass field near the forest when he was attacked from the front by a black bear from the nearby bushes. The people working nearby made the bear run away after the man raised his voice.

The man was retrieved from the bushes and taken to a local hospital. After being administered first aid, the patient was referred to the department of oral and maxillofacial surgery for a severe maxillofacial injury. Because of the prolonged transport, the patient arrived at the center 9 hours after the incident. The patient presented detachment of the entire soft tissue region of the midfacial region.


Fig.1 Photograph showing devastating injury to facial skeleton.

The patient had multiple lacerations throughout the facial region with tissue loss. He was bleeding but was conscious and well oriented to time, place, and space, with stable vital signs. After maintaining the airway, breathing, and circulation, tetanus prophylaxis and antirabies vaccination were given to the patient. The patient's hematologic, biochemical, and radiologic characteristics were investigated.

Computed tomograms and radiographs showed a fracture of the mandible and a fracture of the midfacial region. Because of the extensive nature of the wound and facial fractures, the patient was taken to the operating room for exploration and repair of the laceration and fractures. Preoperatively, he was administered intravenous ceftriaxone plus sulbactam and metronidazole 1.5 g. In the operating room under general anesthesia, the wounds were explored and debrided.


Fig.2 Full-thickness tissue loss on the right side of the nose.

There were leaves, wood splinters, and dust particles throughout the facial region. Further examination showed that the patient had tissue loss over the right medial side of the nose and the right side of the eyelid. Wound cleaning is essential; thus, the wounds were irrigated with povidone and iodine solution, hydrogen peroxide, and saline. Deep or puncture wounds also were cleaned under pressure with a syringe and a needle. After thorough irrigation, surgical reduction of the midfacial region and mandibular fracture was performed with the help of mini plates.

After bony reconstruction and adequate approximation of deep structures, the laceration was closed in multiple layers without sacrificing tissue. A decision was made to repair the tissue loss on the medial side of the nose at a later date. The patient was taken postoperatively to the intensive care unit for observation and was administered intravenous ceftriaxone plus sulbactam and metronidazole every 8 hours and was discharged on postoperative day 15 after good healing and recovery.


Fig.3 Image 18 months postoperatively showing ectropion of the right eye.

Forty-five days later, the patient underwent surgery under general anesthesia for the repair of tissue loss on the medial side of the nose using a pedicled forehead flap. Postoperative recovery was uneventful. The face and scalp are among the sites most resistant to post-traumatic infection because of the rich blood supply to the area. As a result, facial bite wounds, even when sutured, generally are associated with a low infection rate. Apart from the good overall results, complications included multiple facial scars, ectropion of the right eye, and diminished vision of the left side of the eye.

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[ride]

Normally when you see someone in that condition, they already dead.

[koipin]

Very lucky guy.
And if you just look from the one side, he looks fiiiiine

[Caf002]

They did a great job putting him back together!

[kellyhound]

kudos to those surgeons, it's a miracle they can fix such horrific wounds.

[Lil_Lisa]

Originally Posted by ride ↗

Normally when you see someone in that condition, they already dead.

Especially after a 9 hour trip to the hospital. He’s lucky that he’s alive. Not nice to look at but…

[ChristySD]

When I decided on trauma surgery as a specialization eons ago, one professor explained it succinctly, “we take ground hamburger meat on a gurney and stitch it back up into a functioning human”. Oh, so right he was……