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An updated method of replanting a severed auricle is reported. Management consists of early, meticulous replantation with minimal debridement; cooling of the auricle; low-dose heparin sodium; dextran 40; antibiotic coverage; and multiple stab incisions to relieve venous congestion. The regimen is based on experience with nine successfully replanted auricles.

The tube pedicle flap is useful in reconstruction of an absent ear helix. However, immediate tubing of the flap may result in vascular compromise. By elevating a bipedicle flap in the postauricular region and shielding it with a silicone sheet, it is possible to allow the flap to assume a tubular shape while preventing adherence to the underlying suture line. Once mature, the flap maintains both a cylindrical shape and a sufficiently thin external diameter to provide adequate restoration of the ear helix.

A 20 weeks pregnant woman was bitten by a wild bear which took away the central portion of her jaw. A single stage primary reconstruction was performed using a composite pedicled pectoralis major "rib sandwich" island flap. This provided continence of the mouth, allowing her to feed herself within 3 weeks of the operation and to speak reasonably by 6 weeks.

The extended deep inferior epigastric flap, described by Taylor et al. (1983), 1984), offers a versatile and reliable technique for covering defects in the lower limb. A case of shark bite is described in which extensive soft tissue loss in the thigh resulted in a denuded femoral shaft which was successfully treated using such a flap.

Two patients had an avulsing injury of the penis with considerable loss of skin. One was bitten by a dog and the other lost the skin when his clothes were caught by a rotating machine and thus the skin was stripped off by traction and crushed. The detached skin was resutured immediately after injury and in both cases the cosmetic and functional result was more than satisfactory. Though it is not easy to judge the extent of the crush injury in this type of an accident, we feel--even when going against common literature (skin grafting usually is suggested)--that resuturing of the skin is a highly successful method.

The danger of dog bites is often exaggerated. The reason for this is a gram negative bacterium Pasteurella multocida, which causes a serious infection within 12 h. Among 143 dog bites we saw only two of these infections. The bacterial swabs from the mouths of 20 dogs revealed E. coli in 43%, Streptococci in 33%, Proteus in 30%, Staph. epidermidis in 27% and Enterococci in 25%. Since the blood supply of the face is much more superior to that for instance of the legs, infections are rare and primary closure of wounds of dog and human bites is recommended. Additional drainage, hospitalisation and local and systemic antibiotics are possible. Open wound therapy in the face can be called obsolete.

The therapeutic and surgical management of avulsive bite injuries to the face is discussed, and a case is presented in which a flap design was used to reconstruct the lower lip after a severe partial avulsion resulting from a human bite.

Animal bites to the eye and ocular adnexa may result in significant morbidity. Management includes wound care and surgical repair of traumatized tissue, treatment of infection (most commonly Pasteurella multocida), appropriate tetanus and rabies prophylaxis, and notification of state public health officials.

In 11 dogs and 1 cat with thoracic bite wounds and associated internal injury, the most common radiographic findings were subcutaneous emphysema, pulmonary infiltrates (contusion), pneumothorax, and rib separation. Treatment consisted of simple wound cleansing/repair, extensive thoracic surgery, or pleural drainage. Three of the 12 animals died or were euthanatized as a result of their bite wounds, 1 from a nonthoracic injury and 2 as a result of pleural and/or parenchymal disease.

In two years, in our hospital in Nigeria, we saw 16 patients with lower lip losses caused by human bites. These are presented, together with the methods used for early management and subsequent repair.

I have presented a new technique of autologous fat transplantation which utilizes fat obtained by liposuction. I believe that this technique will have wide application in the future of cosmetic and reconstructive surgery.

Dog bite wounds are a common problem and children are the age group at highest risk. Wounds are often multiple and generally involve the face or the limbs. Injuries include punctures, crushes, lacerations and avulsions of flaps. The well-know prevalence of facial injuries can pose some difficult reconstructive problems. Infections are not rare even in well-treated cases. The Authors report the last ten cases which they have treated and on the basis of their experience and of the literature suggest guidelines for effective treatment. A prophylactic antibiotic therapy and tetanus immunization are the basis of rational medical therapy. Wounds should be immediately sutured after careful debridement and through irrigation, unless they are heavily contaminated or located on the hand.

Reconstruction of near the totality of the lower lip after oncological resection or traumatic amputation, is a very challenging problem. The "step technique", introduced by Johanson, allows a good repair of the amputated lip, regarding amplitude, colour and function. The design of the flaps is recalled; and the authors present two cases which demonstrate the good result obtained with this simple but reliable method.

Because of high infection rats and because of possible deformities after radical débridement there is still some restraint in primary wound closure in facial bite injuries. Today the sophistication of facial reconstructive surgery provides the possibility even with injuries with significant skin defects to gain primary healing with satisfactory results from a cosmetic point of view as well as from a functional one.

Dog bites continue to be the most common bite injury in the United States. We previously reported a series of 61 patients with 215 dog bite wounds. Of these, 55 patients had 188 dog bite wounds of the head and neck area which were treated with copious saline pressure irrigation, meticulous wound and wound edge debridement, repeated copious saline pressure irrigation, adequate antibiotic coverage, wound closure, and close postoperative monitoring. A wound infection rate of .53% and a patient infection rate of 1.8% were obtained using this protocol. Our present study uses the same protocol with the exclusion of antibiotic coverage. Our series of 49 patients with 145 head and neck wounds reveals a wound infection rate of 1.4% and a patient infection rate of 4%. This is not statistically significantly different from the outcome of the previous study.

Human bites of the lips are very common. If less than 10 mm in size, they are treated conservatively and if greater, are treated surgically. Many lip bites are treated immediately, when infection is present, surgery is performed a few days later.

Bite injuries by animals in the maxillo-facial-region require special managements of the treating physician or dentist. In the foreground stands the prophylaxis of the rabies. According to the lawful definitions the patient has to be transferred as quick as possible to the next department for rabies and inoculation. The local wound of bite must be treated with rabies-virucid medicaments. Because of aesthetic and functional reasons the primary plastic operation should be done even in cases of extensive wounds and defects in the facial region. By means of 19 cases these demands are based.

Dog bites can be prevented by proper education of children, appropriate selection of family pets and the restraint of guard dogs in the community. An unusually high incidence of bites by German shepherds was observed in this study. Treatment of injuries inflicted by dogs should include: careful wound toilet, appropriate excision of damaged tissues, careful wound repair with adequate drainage and systematic therapy with selected antibiotics.

A new method of reconstruction of the nasal ala is described using a composite free flap taken from the anterior part of the pinna, based upon the superficial temporal vessels. Forty cadaver dissections have been performed to assess variations in vascular anatomy and a direct branch of the superficial temporal artery was found in 90% of subjects. The flap has been used successfully in two cases.

A prospective study was done on 72 cases of human bites of the face. Forty-four patients were found suitable for early surgery, which was performed under antibiotic cover within 5 days after injury. In 35 of the 44 cases antibiotics were started within the first 24 hours (group I) and the results are compared with similar studies. Further comparison is made with 9 patients (20%) (groups II and III) who arrived at hospital late and so did not receive antibiotics until over 24 hours after the bite, although surgery was still performed within the first 5 days. Infection rates were low in all three groups. Wounds were closed directly or definitive surgery done with the use of local flaps or skin grafts. No problems were experienced with these procedures.

A retrospective study of the records of 20 years of experience with injuries from human bites reviewed the results of treatment of 42 patients during the first 10 years and 94 in the second 10 years. In the later series there was less delay in the treatment due to better education of primary physicians as well as of patients. There were fewer complications also. A prospective study of 38 patients, whose treatment consisted of soap and water cleansing, thorough exploration and debridement, hospitalization for at least 48 hours, and administration of antibiotics, showed this treatment resulted in a reduction of the incidence of amputation and stiff fingers despite the fact that 61% of the patients still delayed seeking treatment.

Three different indications for plastic and reconstructive ENT-surgery in children are discussed: Malformations, comprising deformities such as prominent ears and complications (keloids) after their correction, Bonnevie -Ullrich's syndrome etc., Injuries, such as dog-bite lesions of the face with different concepts for reconstructive techniques, and tumour surgery based e.g. on the example of pigmented naevi and haemangiomas.

Five patients with traumatic colobomas of the eyelid secondary to human bites were surgically repaired with retrieved autogenous tissue. All patients were treated with prophylactic intravenous antibiotics. Surgical repair consisted of debridement of the autograft, meticulous layered closure of the autograft to the wound, and placement of a lid margin suture. In two of the patients, mild upper eyelid retraction was noted, and two patients had loss of cilia.

Facial wounds inflicted by bites and scratches during an animal attack require proper wound management and the formulation of a rational treatment plan that considers an important possible sequela--rabies. Presented is a review of the current protocol for the proper evaluation and management of this condition.

A case is presented of a nose bitten off by a dog and successfully replanted by artery-to-artery and artery-to-vein anastomosis. In the absence of vein-to-vein anastomosis, the clinical course suggested that artery-to-vein anastomosis was useful for venous drainage, although the extent to which this contributed to the survival is not known.

A conservative approach allowing the wounds to heal by secondary intention has been used in 14 patients. The results have been very satisfactory, and only six of the 14 patients required minor scar revisions.

Although periorbital and orbital dog bites are rare, they most frequently occur in young children and commonly involve significant associated adnexal injuries. In most cases, the dog is either the family pet or is otherwise known to the victim. The exact precipitating event is usually unknown. Most victims are treated by a physician soon after injury, and can be reconstructed primarily following meticulous local wound care, including adequate irrigation. Infection is rare, but because of its potentially disastrous consequences, prophylactic treatment with penicillinase-resistant penicillin or cephalosporin seems indicated. Serious, potentially fatal consequences due to underlying intracranial injury in children under aged 2 years, fatal septicemia in splenectomized individuals, tetanus, and rabies must be considered by ophthalmologists who treat such patients.

A case is presented of loss of half of the lower lip from a human bite. An Estlander flap was used on the fifth day for reconstruction, with no infection and a good result. This shows the advantage of a "delayed primary closure" in some of these badly contaminated wounds.

A 12-year-old boy suffered from a full-thickness traumatic amputation of his lower lip and chin following a horse bite. Microsurgical technique was used to reanastomose the inferior labial artery and a vein of the chin. The replanted flap remained viable, and the patient has done well despite some early problems with eating and drooling. The patient is now able to purse his lips and has regained sensation and the use of his orbicularis oris and musculus mentalis, even though no attempt was made to repair the motor nerves or sensory nerves. Because of the potential superior cosmetic and functional results following replantation, we recommend aggressive microsurgical attempts at arterial and venous anastomosis not previously described following traumatic amputation. The inferior labial artery may be considered for use as a nutrient artery for replantation and in future elective maxillofacial reconstruction and free-flap transfer.

Over a period of 15 years, 109 patients with 148 dog bites of the face were treated in one Plastic Surgery Unit. In this retrospective review the patterns of injury and treatment are defined with particular reference to specialised anatomical structures involved and the problems of repair. In this study, 87 patients (80%) were under 15 years of age.

Bite wounds made by animals make up 2% of all the injuries. The authors show advantages of the treatment by surgery and by putting primary and secondary sutures. The surgical treatment and putting the primary and secondary sutures added by the use of antibiotics contribute to healing the wounds by first intention in 84,6% of cases.