Emergency department presentations with mammalian bite injuries: risk factors for admission and surgery.

OBJECTIVES: The incidence of animal bite injuries in Australia is high. There is currently no established method for reliably predicting whether a patient with a bite injury will require admission to hospital or surgery. DESIGN: A retrospective audit of mammalian bite injuries at seven major hospitals in Melbourne, Victoria, over a 2-year period. The associations between each predictor and outcome of interest were analysed with univariate and multiple regression analyses. SETTING: Seven major hospitals in Melbourne, Victoria: the Alfred Hospital, Austin Hospital, Frankston Hospital, Monash Medical Centre, Royal Melbourne Hospital, St Vincent's Hospital and Western Hospital. PARTICIPANTS: Patients presenting to emergency departments with mammalian bite injuries. MAIN OUTCOME MEASURES: Hospital admission, intravenous antibiotic therapy, surgery, reoperation, readmission. RESULTS: We identified 717 mammalian bite injuries. The mean age of the patients was 36.5 years (median, 34 years; range, 0-88 years), with an equal number of males and females. The overall rate of hospital admission was 50.8%, and the mean length of stay was 2.7 days. Intravenous antibiotics were administered in 46% of cases; surgery was undertaken in 43.1% of cases. The re-operation rate was 4.5%, the re-admission rate was 3%. CONCLUSIONS: Our study provides a detailed epidemiological analysis of animal bite injuries at seven major hospitals in Victoria. Risk factors for hospitalisation and surgery may assist in identifying patients who require admission and surgical intervention.

The functional free innervated medial gastrocnemius flap.

BACKGROUND: The functional free innervated medial gastrocnemius flap has been described in four previous articles for the management of foot drop, Volkmann contracture, and upper limb muscle defects. We expand the indications by describing the use of free innervated medial gastrocnemius musculocutaneous flap in functional reconstruction of the tongue and upper limb musculature. METHODS: The right medial gastrocnemius muscles were raised as myocutaneous flaps in six patients. These flaps were elevated in the supine position and the flaps included a motor nerve from the sciatic nerve and a sensory nerve from the sural nerve. The average size of flap was 15 × 8 cm. RESULTS: The flaps were transferred successfully with no flap loss and showed consistent reinnervation during follow-up. In particular, all patients who underwent tongue reconstruction exhibited intelligible speech and returned to full oral diet with no aspiration. In patients who underwent upper limb muscle reconstructions, there was moderate to full restoration of power. All donor sites exhibited excellent symmetry in both power and appearance to the contralateral calf. CONCLUSIONS: To our knowledge, this study is the first to describe the use of the innervated medial gastrocnemius free flap in the reconstruction of the tongue and deltoid. The advantages of this flap include its thin reliable skin paddle, strong bulky bipennate muscle, and low donor site morbidity.

The arterial supply of the cervical and thoracic spinal muscles and overlying skin: Anatomical study with implications for surgical wound complications.

Postoperative spinal wound dehiscence is a significant complication following the posterior midline approach. It is postulated that this approach disrupts the vasculature supplying the paraspinal muscles and overlying skin. Although the spinal vasculature has been investigated previously, the smaller arterioles have not been described in the context of the posterior midline approach. Eight cadaveric neck and posterior torso specimens were dissected after injection with a radio-opaque lead oxide mixture and subsequent radiographs taken were analyzed. The deep cervical, vertebral, superficial cervical, and occipital arteries consistently supplied the cervical paraspinal muscles. The latter two arteries also vascularized the overlying skin. The deep cervical arteries were found to be located lateral to the C3 to C6 vertebrae, vulnerable to damage with the posterior approach. In the thoracic region, the superior and posterior intercostal arteries consistently supplied the spinal muscles. In all specimens, two small anastomotic vessels posterior to the laminae were found connecting the intercostal artery perforators. Both the arterial perforators and their anastomotic channels were situated in the surgical field and susceptible to damage with the posterior approach. It is likely that the disruption in spinal vasculature contributes to the multifactorial problem of wound dehiscence with the posterior midline approach.