Staged multidisciplinary management of severe pediatric craniofacial degloving with traumatic orbital loss after a hyena attack in central Tanzania: a case report

Introduction and importance: Severe pediatric craniofacial injuries from hyena attacks are rare and may involve extensive tissue loss, contamination, infection, and complex reconstructive requirements. We report the staged, multidisciplinary management of a child with severe craniofacial degloving and traumatic orbital loss in Tanzania. Presentation of case: After a hyena attack, a 3-year-old girl sustained a severe left craniofacial degloving injury with traumatic loss of the left eye and orbital contents. After same-day referral to a tertiary hospital, she underwent emergency resuscitation and operative debridement, followed by prolonged multidisciplinary wound management and culture-directed antimicrobial treatment. Split-thickness skin grafting and placement of three tissue expanders were complicated by recurrent infection with purulent discharge around the expanders, resulting in removal of all three expanders. After renewed infection control and wound-bed preparation, repeat skin grafting was performed. A residual craniofacial defect remained at discharge, and definitive reconstruction had not yet been undertaken. Clinical discussion: Reconstruction had to be staged and repeatedly adapted according to wound viability and infection, rather than following a fixed operative sequence. Early access to multidisciplinary surgery enabled source control and preserved reconstructive options. The child’s young age and continuing craniofacial growth supported postponement of definitive nasal and orbital reconstruction, and long-term reconstructive and prosthetic rehabilitation will require specialist follow-up. Conclusion: Management of severely contaminated pediatric craniofacial injuries depends on early multidisciplinary surgical care, aggressive source control and infection control, and a staged, rather than immediate, definitive reconstructive strategy that can be adapted as the wound evolves. Long-term reconstructive, prosthetic and psychosocial follow-up is essential.