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Facial injuries from bear attacks: A retrospective analysis highlighting periorbital trauma and the need for tissue
H Wakai1,2, A Onodera1, I Sone1
1Department of Plastic and Reconstructive Surgery, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate Prefecture, 028-3694, Japan.
Objective:
Bear attacks often cause severe facial trauma requiring complex surgical management. We aim to analyze facial injuries caused by Ursus thibetanus and discuss optimal treatment.
Methods:
We conducted a single-center retrospective study of patients with facial trauma caused by bear attacks who were treated at Iwate Medical University Hospital (2017-2022). We analyzed demographic information, injury details (skin, soft tissue, bone involvement), treatment approaches, number of surgeries, and complications. Associations between Facial Injury Severity Scale (FISS) scores, tissue defects, infection, and length of hospital stay (LOS) were evaluated using Spearman's rank correlation coefficient, Mann-Whitney U test, and multivariable regression analysis. p< 0.05 was considered statistically significant.
Results:
A total of 26 patients (22 men, 4 women; median age, 70.5 years [interquartile range (IQR), 66.3-76.5]) sustained facial skin injuries; the eyelid was the most affected site (20 patients). Soft tissue defects were observed in 9 patients and facial fractures in 16 patients. Critical structures (globe, lacrimal canaliculus, parotid duct, facial nerve) were damaged in 14 patients, with 5 globe ruptures. The median FISS was 2.00 [IQR, 1.00-3.00]. Infection occurred in 9 patients. Overall median LOS was 15.0 days [IQR, 9.25- 28.8]. Patients with tissue loss had significantly longer LOS (median, 30.0 days [IQR, 28.0-48.0] vs. 11.0 days [IQR, 8.0-15.0]; p < 0.001). Neither infection nor FISS significantly affected LOS (p = 0.152 and p = 0.820, respectively).
Conclusions:
Bear attacks frequently cause severe facial injuries, often affecting the eyes. Tissue loss significantly prolongs LOS.
