Her left arm wound, with over half circumferential skin and subcutaneous tissue destruction by one deep, long laceration into the forearm musculature, measured 15 cm high?and 4 cm deep (Figure?1). attack, the involvement of her care requiring a multidisciplinary surgical approach via trauma NVP-BAW2881 surgery and plastic surgery, multiple extensive interventions, and the excellent take of the split thickness skin graft (STSG) after the use of a dermal regeneration template (DRT).? strong class=”kwd-title” Keywords: acute trauma care, plastic and reconstructive surgery, skin graft, dermal regeneration template, animal attack, wound healing Introduction Animal bites are a dangerous entity that come with serious health risks and costs, as well as injuries resulting in pain, tissue damage, and disability often requiring frequent and multiple interventions, perhaps ending in severe infection and death?.?Attacks are reported in various forms, including: bites, stings, scratches, pecks, mauls, tramples, falls, thrown from, crushes, or gore?.?From this variety of modalities, assaults by canines are the most common, with a reported nearly four and one half million dog bites occurring annually in the United States?.?Approximately 900 000 people annually are treated in EDs for noncanine injuries, primarily from cats, arachnids, bees, or unknown species, where cat bites account for 400 000 of these attacks?[2-3].?Given the high frequency of attacks as well as significant health concerns and difficult management associated with animal wounds, we report a patient who presented following an attack by an unknown species. She sustained major injuries to the left upper and lower extremities, face, back, shoulder, and ear with recognizable skin loss at the sites, as well as significant subcutaneous tissue and muscle damage to her extremities. These injuries necessitated a multi-disciplinary approach with multiple treatments and procedures, ultimately requiring placement of a dermal regeneration template (DRT) and subsequent split thickness skin grafting (STSG) with excellent functional result. Case presentation The patient is a 30-year-old female, who presented to the ED in extreme pain after walking in the woods and being attacked by an unknown animal. There were significant wounds to her left leg, forearm, shoulder, back, ear, and face with substantial skin, subcutaneous tissue, and muscle damage.?She received a tetanus booster, antibiotics, rabies vaccine, and imaging which revealed no fractures. After evaluation by the trauma team, given the nature, size, and contamination of her wounds, it was felt that emergent multi-disciplinary intervention with plastic surgery was indicated. All wounds underwent pulse lavage and were injected with rabies immunoglobulin. The wounds of the back, ear, shoulder, Rabbit Polyclonal to RAD21 and face were then covered with bacitracin. Her left arm wound, with over half circumferential skin and subcutaneous tissue destruction by one deep, long laceration into the forearm musculature, measured 15 cm high?and 4 cm deep (Figure?1). This was lavaged and debrided, then underwent complex closure. Her leg wound, measuring 15 cm in height and 12 cm in width, had extensive skin, subcutaneous tissues, and muscle involvement, including gastrocnemius, fibularis longus, and soleus (Figures?2-?-3).3). She miraculously had no obvious sign of vascular injury in any wound, and had full range of motion with intact sensation throughout. She continued on antibiotics, compressive wraps were placed, and her leg was splinted to prevent contracture. She returned to the OR on postoperative day (POD) four, where her lower extremity was irrigated with betadine and a bilayer DRT was placed. On POD 16, she returned to the OR where her DRT showed excellent take (98%), and no signs of infection, seroma, or hematoma (Figure?4). A meshed STSG was created and stapled into place. She was seen regularly in the outpatient setting for several months, where her STSG was noted to have 100% take, and her donor site showed appropriate healing (Figure?5). Open in a separate window Figure 1 Near circumferential wound distal to left elbow from animal attack.Imaging taken in the?ED?upon arrival which displays a deep, over half circumferential laceration beginning medially (black arrow) and extending laterally, just distal to the patients left elbow. Open in a separate window Figure 2 Obvious destruction of the patient’s lateral lower leg.ED?imaging following patient’s animal attack displaying?the degree of substantial damage from her attack as well as?contamination of her wound. The solid arrow demarcates the patient’s proximal lower leg, just distal to the knee while the outlined arrow identifies the lateral aspect of the patient’s leg. Open in a separate window Figure 3 Imaging of the patient’s left lower NVP-BAW2881 lateral leg upon arrival to NVP-BAW2881 initial operation.This imaging above not only displays the extent of damage to the patients lower lateral leg, but also highlights the contamination with debris from her surroundings (solid arrows) as well as attacking animal hair (outlined arrows)..