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LETTER TO EDITOR
Year : 2006  |  Volume : 54  |  Issue : 4  |  Page : 287-288

An unusual case of bear bite with severe loss of tissue


Pediatric Ophthalmology and Strabismus, M and J Regional Institute of Ophthalmology, Civil Hospital, Ahmedabad - 380 016, India

Correspondence Address:
Jitendra Jethani
Pediatric Ophthalmology and Strabismus, M and J Regional Institute of Ophthalmology, Civil Hospital, Ahmedabad - 380 016
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.27965

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How to cite this article:
Jethani J, Nagori R, Ghodadara B. An unusual case of bear bite with severe loss of tissue. Indian J Ophthalmol 2006;54:287-8

How to cite this URL:
Jethani J, Nagori R, Ghodadara B. An unusual case of bear bite with severe loss of tissue. Indian J Ophthalmol [serial online] 2006 [cited 2020 Dec 3];54:287-8. Available from: https://www.ijo.in/text.asp?2006/54/4/287/27965

Dear Editor,

We report this unusual case of bear bite that was referred to us for enucleation of the left eye. This was a 53-year-old man who was attacked by a bear in a deep jungle. He was referred to our hospital. Patient had severe bleeding from wound, dislocated jaw, multiple fractures of nasal bone and was delirious at presentation.

On careful examination, we found that there was apparently a severe loss of both lids of the left eye [Figure - 1]a and b. However, the globe was intact and the pupil was reacting to light. It was a degloving injury and the question was how to cover the eyeball? On further examination we found that the whole of the upper and lower lids with part of the lateral canthus and medial canthus was lodged in the fracture of nasal bone. On removing this tissue by gradual peeling we could see there was no soft tissue loss at all!

The outer coats were sutured keeping in mind the anatomical landmarks of the different layers. The end result was a satisfactory closure of the defect and adequate covering of the globe [Figure - 2].

Various procedures have been used for extensive tissue loss. These include tubed pedicle flaps and interpolation flaps.[1],[2] An interpolation flap is a two-stage tissue flap in which the base of the flap is not brought immediately adjacent to the recipient site. These flaps are used when insufficient tissue or mobility in nearby skin prevents coverage of a surgical defect with primary closure or an adjacent flap. Interpolation flaps are similar to transposition flaps in that the flap is lifted over an area of normal skin to reach the defect.[2] The chance of a human encountering a bear is on the rise as the remote bear territory is diminishing.[3]

Bear bites are commonly complicated by postoperative infections.[4],[5] However, in our patient, there was no postoperative infection and the wound was healthy. The patient was lost to follow-up.



 
  References Top

1.
Nara T, Handa S, Tochiuchi H, Minato M. Facial reconstruction with tubed pedicle flaps in extensive soft tissue loss after a bear bite. Keisei Geka 1971;14:502-6.  Back to cited text no. 1
[PUBMED]    
2.
Herford AS. Early repair of avulsive facial wounds secondary to trauma using interpolation flaps. J Oral Maxillofac Surg 2004;62:959-65.   Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.
Dieter RA Jr, Dieter DL, Dieter RA 3rd, Forbes B. Bear mauling: A descriptive review. Int J Circumpolar Health 2001;60:696-704.   Back to cited text no. 3
[PUBMED]    
4.
Lehtinen VA, Kaukonen T, Ikaheimo I, Mahonen SM, Koskela M, Ylipalosaari P. Mycobacterium fortuitum infection after a brown bear bite. J Clin Microbiol 2005;43:1009.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.
Kunimoto D, Rennie R, Citron DM, Goldstein EJ. Bacteriology of a bear bite wound to a human: Case report. J Clin Microbiol 2004;42:3374-6.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure - 1], [Figure - 2]


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