Main Article Content
Background: A hyena bite to the face of a live adult human is one of the rarest cases and is hardly reported in India. The central face is an intricate 3-Dimensional structure and is a dominant feature of a human being. A complex central facial defect can severely affect a person’s appearance and function; and poses a substantial challenge for reconstructive surgeons. The aim and principles of central facial reconstruction are to achieve adequate function and aesthetics.
Case Report: This report describes a very rare case of a 43-year-old man, resident of a rural part of Rajasthan state of India, who sustained a massive injury in the central face after getting bitten by a hyena. A free radial forearm flap was designed as a multiple folding, double paddle flap that was divided into several portions. The folded portions of the flap were used to reconstruct the nose, oral mucosa and the upper lip defects and while a downturned forehead flap provided the lining for nasal mucosa reconstruction. The patient achieved a good functional recovery and had a good aesthetic outcome.
Conclusion: One of the rarest cases reported in the literature, where timely intervention was done is nothing short of a miracle. Meticulous preoperative planning and harvesting of flaps enabled the achievement of good aesthetic and functional results in the present patient.
Gilyoma JM, Mabula JB, Chalya, PL. Animal-related injuries in a resource-limited setting: Experiences from a Tertiary health institution in Northwestern Tanzania. World J Emerg Surg. 2013;8:7.
Mitchell KB, Kotecha VR, Chandika A. Bush animal attacks: Management of complex injuries in a resource-limited setting. World J Emerg Surg. 2011;6:43.
Fell MJ, Ayalew Y, McClenaghan FC, McGurk M: Facial injuries following hyena attack in rural eastern Ethiopia. Int. J. Oral Maxillofac. Surg. 2014;43:1459–1464.
Pribaz APA, Julian JMD, Weiss Denton D. MD, Mulliken John BMD, Eriksson Elof MD. Ph.D. Prelaminated Free Flap Reconstruction of Complex Central Facial Defects, Plastic and Reconstructive Surgery. 1999;104(2):357-365.
Eckardt A, Fokas K: Microsurgical reconstruction in the head and neck region: an 18-year experience with 500 consecutive cases. J Craniomaxillofac Surg. 2003;31:197.
Li YY, Sun JE, Li G, et al. Reconstructing a full-thickness cheek defect of electrical burn with a folding radial forearm flap. J Oral Maxillofac Surg. 2013;71:1811.e1.
Zhou W, Mingwu H, Youqiao L, Zhongjun Y. Reconstructing a complex central facial defect with a multiple-folding radial forearm flap. J Oral Maxillofac Surg. 2014;72(4): 836.e1-4.
Grajek M, Maciejewski A, Szumniak R, et al. The use of three free flaps in the simultaneous reconstruction of the nose after extensive resection due to malignant cancer. Pol Przegl Chir. 2012;84:99.
Henry EL, Hart RD, Mark Taylor S, et al. Total nasal reconstruction: Use of a radial forearm free flap, titanium mesh, and a paramedian forehead flap. J Otolaryngol Head Neck Surg. 2010;39(6):697-702.
Salibian AH, Menick FJ, Talley J. Microvascular Reconstruction of the Nose with the Radial Forearm Flap: A 17-Year Experience in 47 Patients. Plast Reconstr Surg. 2019;144(1): 199-210.
Otero-Rivas MM, González-Sixto B, Alonso-Alonso T, Pérez-Bustillo A, Valladares-Narganes LM, Rodríguez-Prieto MÁ. Titanium mesh in reconstructive surgery of the nasal pyramid. Follow-up of our 11 initial cases. Int J Dermatol. 2015; 54(8):961-965.
Shipkov H, Traikova N, Stefanova P, et al. The forehead flap for immediate reconstruction of the nose after bite injuries: Indications, advantages, and disadvantages. Ann Plast Surg. 2014; 73(3):35