news

한어Русский языкEnglishFrançaisIndonesianSanskrit日本語DeutschPortuguêsΕλληνικάespañolItalianoSuomalainenLatina

due to various factors, many people give up halfway through treatment.

written by | yan xiaoliu

"have you seen the movie 'painted skin'? the one where the skin is lifted up..." cui wei, a plastic surgeon at sichuan provincial people's hospital, told "medical world" that this was his first impression of mr. liu.

that day, 71-year-old mr. liu was attacked by a black bear. his nasal bones and maxilla were extensively fractured, and his bones collapsed. his facial skin was torn off, his soft tissue was widely displaced, and there were deep contusions. one nostril moved to the cheek.

such attacks by wild animals are common in sichuan provincial people's hospital and occur every year. cui wei said that about a month before mr. liu was admitted to the hospital, he and his team had just received a case of a middle-aged man whose nose was bitten off by a black bear.

based on his rich experience in dealing with "boonie bears", cui wei has a set of diagnosis and treatment plans, which involve multiple steps such as debridement, suturing, repair, and reconstruction. but he regrets that due to various factors, many people give up halfway through the treatment.

on the morning of august 7, 71-year-old mr. liu went up the mountain to pick matsutake mushrooms and was attacked by a black bear. the most serious injuries were mainly concentrated on the face. photo source: sichuan provincial people's hospital

do everything you can to save the organization

according to his family, at about 7 a.m. on the day of the incident, mr. liu went to the nearby mountain to pick matsutake mushrooms as usual. as soon as he climbed a small slope, he saw a black bear lying on the ground.

the man and the bear were only about one meter apart. the bear pounced forward and pinned uncle liu under its palm, then swung its palm towards uncle liu's right face, tearing his skin and flesh. one end of the skin was tied to uncle liu's face, and the other end was torn off and hung down to his mouth.

soon after the attack, the black bear got up and ran away. mr. liu took off his clothes, wrapped the wound on his face, and quickly fled the scene, calling his wife for help.

"the damage is severe." cui wei recalled the appearance of uncle liu when he was sent to the hospital, saying that his entire face was collapsed and deformed like a house with its main beam collapsed.

the most urgent task is to perform emergency debridement and bandaging. cui wei admitted that this is the first hurdle that the treatment team and mr. liu have to overcome.

mr. liu's injuries were complicated, with a large and deep wound, and blood scabs and dirt embedded in the wound. various pathogens carried by soil and black bears may have taken the opportunity to enter the wound, causing infection, severe corruption, and ulceration of the wound.

in theory, the entire debridement process is like preparing food, which requires washing away all stains and removing rotten parts. "the difference is that every inch of human tissue is useful and cannot regenerate in most cases. medicine can certainly be more radical and remove all inactive and suspected infected parts at once. but our goal is to save a face as much as possible," said cui wei.

he and his team repeatedly flushed the wound with large amounts of saline, hydrogen peroxide, etc., thoroughly explored the deep inside, and carefully picked out broken and necrotic tissues, bones, etc.

after doing all this, cui wei did not close the wound immediately, but covered and bandaged it. he hoped to ensure that the dirt inside the wound was discharged and the damaged tissue could be saved as much as possible through active systemic anti-infection treatment, dressing changes, and adequate drainage.

this is called "delayed suturing" and is generally suitable for those who have been injured for more than 24 hours, have large and deep injuries, or have large soft tissue defects and severe contamination in the wound.

but this is a double-edged sword. the wound surface is exposed, and there is continuous leakage of tissue fluid and bleeding, which may increase the risk of infection. once it develops into an explosive infection, or the infection enters the blood and causes sepsis, it will be fatal.

in response, the medical team immediately used broad-spectrum antibiotics on mr. liu. later, the medical team conducted bacterial culture and drug sensitivity tests on wound secretions and removed necrotic tissue, and no drug-resistant or highly lethal strains were found.

"the patient's local infection was well controlled and no higher-level antibiotics were used. this is a good phenomenon," said cui wei.

image source/provided by the interviewee

“one step away”

about two weeks after being admitted to the hospital and undergoing three debridement operations, mr. liu's treatment finally entered the second stage: wound closure.

during the operation, cui wei straightened and gathered the organs, tissues, bones, etc. that were scattered everywhere, and returned them to their original positions as much as possible. the face has dense nerves and blood vessels, and the diagnosis and treatment team was meticulous and careful to avoid secondary damage. then, the skin was pulled together and sutured. cui wei couldn't remember exactly how many stitches were needed, but it must have been hundreds.

around august 30, mr. liu was successfully discharged from the hospital. at this time, his postoperative skin flap was completely alive, the facial wound was basically repaired, and the physiological functions of his organs were close to normal. however, his face changed significantly, and the asymmetry could be seen at a glance.

according to cui wei's treatment plan, mr. liu will have to return to the hospital half a year later for the third stage of treatment, aimed at reconstructing his facial appearance.

at that time, the diagnosis and treatment team will perform ct three-dimensional reconstruction of his head and face, obtain data, make models, and simulate the surgical process. cui wei plans to use polymer artificial materials such as titanium alloy to fill in the missing tissues of mr. liu. in layman's terms, it is like replacing a beam in a house to support the main structure to significantly improve facial deformities.

artificial materials are used for their hardness and plasticity, so that they can be molded into a shape that is both functional and aesthetic, which is impossible with autologous fat, autologous bone, etc.

in cui wei's vision, after completing the third stage of treatment, mr. liu's face will be close to normal and will not look out of place at first glance.

this confidence may stem from the department's rich experience in receiving patients, and is also related to the surgical precedents that have been completed in our country.

in recent years, there have been many cases of bear-related injuries in many parts of my country, many of which have serious facial damage and require repair and reconstruction.

in 2016, the plastic surgery department of xijing hospital of the fourth military medical university received a patient whose face was "broken" after being bitten by a bear. his entire maxillofacial tissue was severely damaged, his eyeballs were ruptured, he had multiple comminuted fractures all over his face, and multiple soft tissue avulsions throughout his body. with the help of craniomaxillofacial 3d printing and design technology, the hospital reassembled the shattered facial bone tissue and successfully restored the main structure of the facial bones and the clenching function. the entire operation lasted 11 hours.

earlier in 2007, a patient in my country who was seriously injured by a bear underwent facial reconstruction through an allogeneic facial transplant. this was the second allogeneic facial transplant in the world.

"but i know that the old man will not come back." cui wei told the "medical world" bluntly that due to a combination of factors such as family situation and surgical costs, those patients who are older and bitten or scratched by bears are very likely to "lose contact" after the wound is closed. it becomes particularly difficult to track the effect of early treatment, let alone facial repair and reconstruction.

one of the biggest regrets caused by this is that it is difficult for clinicians to collect complete information and write papers for peer reference and guidance in practice. "medical world" searched databases such as wanfang and found that there are only a limited number of papers related to bear injuries.

cui wei said that in most cases, the treatment process and principle of bear wounds are similar to those of facial injuries and deformities caused by car accidents and fights. the main difference is that the wounds caused by animals are less clean, more difficult to resist infection, and the healing period is significantly longer.

currently, cui wei is waiting for a 50-year-old middle-aged man to return to the hospital. in june this year, he was attacked by a black bear, and the tear duct of his right eyelid was broken. a large part of his nose was bitten off. he needs to undergo 2-3 operations to repair and reconstruct the shape of his nose. the "medical community" will continue to pay attention to his latest progress.