Management of a Nipple Injury Causing Nipple Bifurcation and Infection

Military physicians working in resource-constrained environments, including reduced access to care, must evaluate for any circumstances that would necessitate an aeromedical evacuation to a higher level of care; this is particularly important in foreign countries. Due to these circumstances, military physicians must be resourceful while maintaining expertise to stabilize and treat any medical issue whether or not evacuation is requested. A 26-year-old female requested urgent care evaluation after she endured an accidental traumatic nipple stud removal at an austere military base located in Egypt. Upon initial evaluation at the base clinic, a left nipple bifurcation was identified. The case was complicated by a subsequent spontaneously draining bacterial infection at the base of the bifurcation, which resolved without further complication following antibiotic course and daily monitoring. Furthermore, adhesive strips were applied daily to approximate the nipple, which was critical to the restoration of gross anatomy. As such, the nipple bifurcation was held in place utilizing adhesive strips, thereby producing counterforce to facilitate healing by primary intention for two weeks resulting in a favorable cosmetic outcome. Ultimately, the patient's clinical course resulted in a well-healed and well-approximated linear scar on her left nipple. Long-term distal milk duct function is unable to be assessed outside of lactation periods or advanced imaging, but given the location and extent of the injury, a plastic surgery evaluation and imaging were deferred. This case report outlines the management considerations, literature search, and treatment course of a rare, unreported injury type in an austere, military environment along with consideration of future research.