Human bites of the hand: the Tasmanian experience.

INTRODUCTION: The purpose of the present paper is to provide geographically representative information on the presentation, treatment and complications of human bites of the hand in Australia. METHODS: A 5-year retrospective study was undertaken of patients treated at Royal Hobart Hospital for human bites of the hand. The variables evaluated included age, sex, hand involvement, anatomical distribution, presentation, operative findings, bacteriology, antibiotic use, X-ray findings, complications and compliance. RESULTS: Thirty-five patients had human bites to the hand. All were male with a median age of 24 years. Most were clenched fist injuries with the middle metacarpophalyngeal joint being the most prone to injury. Patients presenting early had a high incidence of open joints and fractures but spent less time in hospital than late presenters, almost all who had infection complications. Compliance with treatment was found to be a major problem. Serious hand infections were not observed. CONCLUSION: The treatment of human bites must be early, correct and comprehensive. The appropriate treatment is surgical exploration with debridement and lavage, appropriate antibiotic administration, hand elevation and initial immobilization. Poor compliance of patients in the present study was demonstrated by a high incidence of late presentation, self-discharge from hospital and loss to follow up, making assessment of outcomes difficult. Despite this there is an absence of serious hand infections reported in the literature and this may be due to the administration of antibiotics prior to referral.

Infraorbital nerve block in neonates for cleft lip repair: anatomical study and clinical application.

Infraorbital nerve block in neonates is not well described although it has been suggested that bilateral infraorbital nerve block is the local analgesic technique of choice for early repair of cleft lip. The purpose of this study was to determine the location of the infraorbital nerve in neonatal cadavers and to identify clinically useful landmarks. Thirty infraorbital nerves were identified in 15 neonatal cadavers with a mean weight of 2.85 (SD 0.32) kg (range 2.45-3.5 kg) via an upper buccal sulcus incision. The mean distance from the infraorbital nerve to the base of the alae nasi was 7.7 (SD 1.3) mm on the left and 7.5 (0.8) mm on the right. A line drawn from the angle of the mouth to the midpoint of the palpebral fissure measured 30.6 (1.9) mm (left) and 30.7 (1.8) mm (right). The nerve was situated approximately halfway along this line at a point 15.5 (1.5) mm (left) and 15.2 (1.4) mm (right) from the angle of the mouth. These measurements were used to perform bilateral infraorbital nerve blocks in four neonates undergoing cleft lip surgery under general anaesthesia, thereby providing analgesia with minimal risk of respiratory depression.

A modified subcutaneously pedicled nasolabial flap for circumferential lining of the nasal vestibule.

A new modification of the subcutaneously pedicled nasolabial flap is described to replace large circumferential deficiencies in nasal lining. The advantages of this method are that the airway is not obstructed by flap bulkiness, prolonged splintage is not required and entirely circular scars in the nasal vestibule, which may contract, are avoided.