Microsurgical scalp reconstruction after a mountain lion attack.

Mountain lion attacks on humans are rare and potentially fatal. Although few victims experience minor injuries, permanent disfigurement and disability is common among survivors of these assaults. Since 1986, a steady number of mountain lion attacks have been noted in California. We report a recent attack of a cougar on a couple hiking in California's Prairie Creek Redwoods State Park. The victim sustained a significant scalp injury that led to a life-threatening soft-tissue infection. We present an analysis of the injury pattern as it relates to the bite marks, the resulting degloving injury, and the surgical reconstruction. We also offer a current survey of the pathogens often found in cats' and mountain lions' bite wounds and the appropriate antibiotic treatment. Given the infrequency at which clinicians encounter mountain lion injuries, we recommend that after initial management and exclusion of life threatening injuries patients be transferred to a tertiary care facility capable of managing the various reconstructive challenges such as the one presented in this case.