Treatment Options for Horse Bite Injuries During Childhood

The main localisation of horse bites is the face, and the most common victims are children of pre-school and school age. Acute care of these injuries is an issue of concern. The often sharply limited, round soft tissue defects raise questions about thorough diagnosis, evaluation of facial nerve function, and the structural integrity of the parotid gland duct, and thereafter about structured primary care. Besides hemostasis and reconstruction of the and duct, the question about immediate reconstruction must be answered. The primary care of three cases and the long-term outcome after 20 years of one case are presented. All cases had deep wounds of the cheeks, about palm-sized, with muscle involvement. In one case, local defect coverage was possible because of the good movability of the cheek skin. In both other bite wound cases, which were associated with avulsion of tissue, replantation of the minimally pedicled skin flaps was initially done. Both patients developed secondary non-infected flap necrosis, which was removed successively. Then granulation, epithelialisation, and scarring were waited for in both cases. One year after primary treatment, scar revision was performed. In all three cases, satisfying aesthetic and functional rehabilitation were achieved without further relief incisions, pedicled local or distant flaps, or synthetic skin substitutes. Keywords: horse bites, children, animal bite