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From the 2023 4th Quarter Pressure

Richard "Gus" Gustavson, MPH, RN, CHRNC, CWCN, CHT, CRT

Creative Solutions & Reconstructive Principles after Grizzly Bear Mauling: Presentation by Guest Speaker: Lily Daniali, MD, FACS

The Associate Townhall concept was introduced to provide a venue for topics related to Hyperbaric Medicine, but may not meet the threshold for continuing education units.  The associate council wanted to offer topics to the Associate membership that expanded their overall knowledge in the Diving and Hyperbaric Medicine world.

The Townhall meeting for November 2023 was an interesting case study in which hyperbaric treatments were used to enhance the healing involved, even though the primary reason for the success was the skill and talent of the surgeons involved.

Lily Daniali, MD, FACS, a multiple board-certified plastic surgeon at Swedish Medical Center in Englewood, Colorado, made the presentation. In addition to her practice in plastic surgery, she was also the Medical Director of the Center for Wound Healing, with certification in hyperbaric medicine. Swedish Medical Center is a Level One Trauma Center, an ABA-accredited burn center, and a UHMS-accredited Hyperbaric Medicine facility.

This case involves a degloving injury of the face in a 57-year-old man who had an unfortunate encounter with a mama bear. The incident resulted in multiple traumas, including a degloving injury to his mid-face, which was a total detachment of his nose and surrounding tissue. After the attack, the avulsed facial tissue was lying on the ground next to the victim, and he had the presence of mind to place that tissue in his pocket. He was intubated on-site in Wyoming for transport to Swedish, where he was immediately assessed and stabilized by the trauma team.

Over the next three years, he underwent multiple surgeries. Although indicated, he was not treated in hyperbaric due to his critical care status during this initial treatment regime. Although the entire case was interesting, one of the fascinating aspects was “parking” the intact nose and surrounding tissue on the patient’s forearm to provide circulation to preserve the tissue. At the same time, they prepare the site for reimplantation.

You can view the photos of the injury and the various steps taken to reach the end result, including preserving the patient's function and appearance/identity. This written description does not do justice to the skill of the surgeons treating a trauma of this complexity.

UHMS members can access this recording and other town hall presentations at the following link -  

Associates Town Hall Meetings - Undersea & Hyperbaric Medical Society (