Abstract
Background Human bite wounds in emergency department need evaluation in regard of reconstruction.
These are due to occlusive bite injuries over face. Most commonly, human bites over
face involve ear and nose, and may lead to avulsion injury. Defects over nose can
be reconstructed immediately after debridement or delayed till the wound heals and
scar becomes supple. Thorough wash and lavage with broad- spectrum antibiotic cover
has utmost importance in preventing cartilage infection.
Methods We report 20 cases of human bite injuries over nose who presented to us in emergency
department between 2018 and 2020. At the time of presentation the wound was assessed
for closure. If not possible, patient was planned for delayed reconstruction after
3 months. In case delayed reconstruction was planned, the skin and nasal mucosa were
approximated at first presentation. The patients underwent paramedian forehead flap
after recreation of defect with conchal cartilage graft. Second stage of flap detachment
and insetting was done after 3 weeks. After three weeks of second stage, third stage
of flap thinning was done. Patients were followed for 3-6 months and subjective satisfaction
was noted.
Results Nineteen patients underwent delayed staged reconstruction with paramedian forehead
flap and one underwent primary wound closure. The flap survival was 100%. The patient
satisfaction was excellent in most cases.
Conclusion We recommend delayed reconstruction for human bite nasal injuries. For reconstruction,
paramedian forehead flap with conchal cartilage graft, if required, provides excellent
reconstructive option with good contour and color match and minimal donor site scar.
Keywords
human bite nose - reconstruction - forehead flap
