Crocodile bite scalp avulsion and hand extensor tendons injury: A rare case reconstructed in a tertiary hospital, in Tanzania

ABSTRACT Introduction and importance: Crocodile bites on humans are rare but can lead to life-threatening injuries that most commonly affect the extremities and are often characterized by fractures and severe soft tissue avulsion. This case highlights 20 years-old fisherman, victim of crocodile bite, managed in a plastic surgery unit of a tertiary hospital in Tanzania. Presentation of the case: A 20 years old male was attacked by a crocodile during night fishing activity and was rescued by fellow fishermen. Conducted to a peripheral hospital, resuscitation, antibiotics therapy, tetanus prophylaxis and debridement were initiated. He was then referred to a tertiary hospital where the assessment shown a 15 × 8 cm open debrided wound on the left fronto-parietal area and injuries on 4th and 5th extensor digitorum tendon and on the extensor digit minimi tendons repaired by the modified Kessler technique. Scalp defect was reconstructed by a right fronto-parietal transposition flap later. Functional and cosmetic outcomes were acceptable. Clinical discussion: Crocodile bite is dangerous and requires quicker reference to a health facility that should initiate resuscitation, antibiotics and tetanus toxoid. Optimal definitive management is done in a tertiary care center. Biomechanically, Modified Kessler is the most superior tendon repairs technique. The large size of scalp defect motivated its reconstruction by a transposition flap. Functional and cosmetic results were similar to other studies. Conclusion: Crocodile attack survivors suffer from large wounds with significant tissue destruction. To improve outcomes, early initiation of resuscitation, antibiotic therapy, and tetanus prophylaxis is essential. Definitive management, including soft tissue reconstruction, should be carried out at a tertiary hospital. Highlights