# Complex soft tissue and facial bone reconstruction after a bear attack in Indonesia: a case report of definitive management following an 8-hour interfacility transfer

## TL;DR

A 68-year-old woman survived a severe bear attack in Indonesia and underwent complex facial reconstruction after an 8-hour transfer to a medical facility.

## Contribution

This case report presents a rare and detailed account of managing severe facial trauma from a bear attack in a resource-limited setting.

## Key findings

- The patient had full-thickness hemifacial avulsion and facial bone fractures requiring wire fixation.
- Ocular exenteration and soft-tissue closure were performed to manage the injury.
- Staged reconstruction and multidisciplinary care were crucial for functional and aesthetic recovery.

## Abstract

Bear attacks, although rare, may result in severe maxillofacial trauma, highlighting the devastating consequences of human-wildlife conflict in rural areas. Bear maulings typically cause cutting, penetrating, and crushing injuries, with most victims sustaining contaminated maxillofacial trauma requiring comprehensive management to prevent complications. We report a case of a 68-year-old woman presenting with sustained severe left-sided facial trauma following a bear attack. The patient had a full-thickness hemifacial avulsion, fractures of the zygomaticum and maxilla, and a non-salvageable ocular injury after an 8-hour transfer. Management included debridement, wire fixation of fractures, ocular exenteration, and anatomically re-approximated soft-tissue closure. This case highlights the importance of early trauma principles, effective infection control, and tailored fixation strategies for fragile facial bones. It emphasizes the need for staged reconstruction planning in resource-limited and geographically distant settings. Integrated multidisciplinary management and meticulous surgical decision-making are essential for achieving functional and aesthetic recovery in such complex injuries.