Alligator Assault: A Systematic Literature Review and Case Series at a Florida Level 1 Trauma Center.

Background: Alligator bites are a rare occurrence, though some literature on injurious human-alligator interactions exists. This report details 3 cases of alligator bite-related wounds with characteristic extensive tissue damage and subsequent reconstruction. We also review the literature on caring for this specific population. Methods: The authors present a systematic literature review on alligator bite-related sequalae and care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed throughout the systematic literature review. The authors also present a case series of patients wounded by alligators who each presented to a large tertiary academic center on the west coast of Florida. Results: Early debridement, prophylactic antibiotics, soft tissue reconstruction, and interdisciplinary care are the main tenets of care for patients who sustain alligator bites. Case 1 was a 53-year-old man with a left upper extremity bite with significant neurovascular damage and near transradial amputation who underwent emergent revascularization. After multiple attempts at limb salvage, the patient underwent formal transradial amputation. Case 2 was a 77-year-old woman with bites to her left upper and lower extremities, with concern for lower extremity Morel-Lavallée lesion. The lower extremity wound was reconstructed with lateral gastrocnemius muscular and fibularis longus musculocutaneous flaps and split-thickness grafting; ultimately, transradial amputation was necessary for the upper extremity after evidence of devascularization. Case 3 was a 34-year-old man with a facial injury and skull fracture. After initial operative repair of the facial nerve and soft tissue lacerations, the patient required later revision with cranioplasty and temporalis coverage because of a draining wound. All 3 patients survived their severe injuries. Conclusions: This case series represents a unique set of patients maimed by alligators and their subsequent surgical management. Recommendations from the literature review include an interdisciplinary approach, early operative investigation and initiation of broad-spectrum antibiotics, and to consider a staged reconstruction for these injuries.