Article Figures & Data
Figures
- Figure 1
(A) Shark-related injuries by time of day. Intervals are from :00 to :59. Example: 06:00 is from 06:00 to 06:59. (B) Shark-related injuries by month.
- Figure 2
(A) Level 2 injury from cookiecutter shark bite to the left posterior shoulder. Distinctive “punched-out” bite pattern pathognomonic of a cookiecutter shark. Underwent operative debridement and wound closure. (B) Level 3 injury from a tiger shark to the left lower extremity (LLE). Obvious bite marks to the thigh with shark dentition pattern evident. Sustained traumatic arthrotomy of the knee, complete biceps femoris tendon laceration, and complete laceration of the common peroneal nerve. Underwent two operative debridements, repair of tendon, and delayed primary repair of the peroneal nerve. (C) Level 5 injury from a tiger shark. Bilateral tibiotalar joint dislocations with extensive soft tissue injuries. Right lower extremity (RLE) with anterior and posterior tibial artery injuries. LLE with anterior tibial artery injury only. Revascularization of RLE attempted but graft occluded and the patient underwent secondary below knee amputation of RLE the next day. Left lower extremity salvaged with transtibiocalcaneal pins, multiple tendon repairs, four operative debridements, and latissimus/serratus free flap with split-thickness skin graft placed 9 days after injury. Pseudomonas aeruginosa cultured from LLE wound 5 days after injury and treated with cefepime and surgical debridement.
- Figure 3
Level 4 injury from a tiger shark. (A, B) Traumatic below knee amputation (BKA) of the right lower extremity (RLE). (C, D) Deep lacerations to the right upper extremity (RUE) with traumatic wrist arthrotomy and lacerated median nerve, ulnar nerve, ulnar artery, and multiple tendons. After undergoing operative debridement of RUE and RLE and provisional revision amputation of RLE, the patient was transferred to The Queen’s Medical Center for hand surgeon expertise. All injured structures of RUE were repaired. A total of four operative debridements were performed to RLE prior to transfer to mainland for complex wound coverage of BKA site.
Tables
- Table 1
Characteristics of all shark-related injuries in the state of Hawai’i
Survived, n (%) 57 (93) Fatal, n (%) 4 (7)—all on Maui Total 61 Island, n (%) Maui 25 (41) O’ahu 16 (26) Hawai’i 12 (20) Kaua’i 8 (13) Shark species, n (%) Unknown/data insufficient 26 (43) Tiger 25 (41) Cookiecutter 4 (6.6) Galapagos 2 (3.3) Requiem 2 (3.3) Galapagos or sandbar 1 (1.6) Whitetip reef 1 (1.6) Water clarity, n (%) Turbid 35 (57) Clear 24 (39) Unknown 2 (3.3) Activity of unprovoked incident, n (%) Surfing 20 (33) Swimming 14 (23) Snorkeling 8 (13) Body boarding 3 (5) Treading water 2 (3.3) Paddling 1 (1.6) Stand-up paddle boarding 1 (1.6) Floating 1 (1.6) Spearfishing 1 (1.6) Standing 1 (1.6) Kite surfing 1 (1.6) Total 53 (87) Activity of provoked incident, n (%) Swimming with sharks 4 (6.6) Spearfishing 2 (3.3) Fishing 1 (1.6) Fishing from kayak 1 (1.6) Total 8 (13) - Table 2
Nature of shark-related injuries treated at The Queen’s Medical Center
n=12 Single site 7 Multiple sites 5 Two sites 4 Three sites 1 Most severe level of injury per patient Abrasion/contusion 0 Skin or soft tissue injury 1 Tendon/muscle/bone injury 8 Major vascular injury, includes isolated vascular injuries and amputations 3 Upper limb injuries, most proximal extent 8 Hand 2 Forearm 3 Elbow 1 Upper arm 0 Shoulder 2 Lower limb injuries, most proximal extent 9 Thigh 5 Lower leg 4 Foot 0 Abdomen 1 Vascular injury* Ulnar artery† 1 Anterior tibial artery‡ 1 Amputation/disarticulation Below the knee† 2 Above the knee 1 Nerve injury* Ulnar nerve 2 Radial nerve 2 Median nerve 1 Lateral antebrachial cutaneous nerve 1 Peroneal nerve 1 Shark-induced trauma level, n (%) Level 5 1 (8.3) Level 4 3 (25) Level 3 4 (33) Level 2 4 (33) Level 1 0 (0) *Excluding traumatic and secondary amputation.
†One patient had a traumatic BKA and ulnar artery injury (see figure 3).
‡One patient had ipsilateral anterior and posterior tibial artery injuries. Revascularization was unsuccessful and necessitated secondary BKA. The contralateral leg had an anterior tibial artery injury (see figure 2).
BKA, below knee amputation.
