title: Shark attack-related injuries: Epidemiology and implications for plastic surgeons.
abstract: OBJECTIVE
  The increased media attention to shark attacks has led to a heightened fear and public awareness. Although few sharks are considered dangerous, attacks on humans can result in large soft tissue defects necessitating the intervention of reconstructive surgeons. This study aims to evaluate and describe the characteristics of shark-related injuries in order to improve treatment.
  
  
  METHODS
  The Global Shark Accident File, maintained by the Shark Research Institute (Princeton, NJ, USA), is a compilation of all known worldwide shark attacks. Database records since the 1900s were reviewed to identify differences between fatal and nonfatal attacks, including: geography, injury pattern, shark species, and victim activity.
  
  
  RESULTS
  Since the 1900s, there have been 5034 reported shark attacks, of which 1205 (22.7%) were fatal. Although the incidence of attacks per decade has increased, the percentage of fatalities has decreased. Characteristics of fatal attacks included swimming (p = 0.001), boating (p = 0.001), three or more bite sites (p = 0.03), limb loss (p = 0.001), or tiger shark attack (p = 0.002). The most common attacks were bites to the legs (41.8%) or arms (18.4%), with limb loss occurring in 7% of attacks. Geographically, the majority of attacks occurred in North America (36.7%) and Australia (26.5%). Most attacks in the USA occurred in Florida (49.1%) and California (13.6%).
  
  
  CONCLUSIONS
  Although rare, shark attacks result in devastating injuries to patients. As these injuries often involve multiple sites and limb loss, this creates a significant challenge for reconstructive surgeons. Proper identification of the characteristics of the attack can aid in providing optimal care for those affected.
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth, Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: jaricci@partners.org.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Ricci
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth, Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: christinarvargas@gmail.com.
authors.forename: Christina R
authors.initials: CR
authors.lastname: Vargas
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida Health System, University of Florida School of Medicine, Gainesville, FL, USA. Electronic address: dhruv.x.singhal@gmail.com.
authors.forename: Dhruv
authors.initials: D
authors.lastname: Singhal
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth, Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: btlee@bidmc.harvard.edu.
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
mesh_terms: D000328:Adult; D000818:Animals; D001733:Bites and Stings / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D008297:Male; D009104:Multiple Trauma; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012754:Sharks
keywords: Animal bites; Infections; Multi-trauma; Shark attack