面颈部哺乳类动物咬伤100例治疗体会

目的:探讨面颈部哺乳类动物咬伤的治疗经验。方法:哈密地区中心医院五官科2006年1月～2011年12月急诊收集100例哺乳类动物咬伤头颈部的病例,采用Ⅰ期清创、美容缝合、预防感染、免疫接种治疗。结果:87例患者创口Ⅰ期愈合,10例行Ⅱ期整复手术,3例术后出现感染延期愈合。结论:动物咬伤应尽可能行Ⅰ期清创、美容缝合,对于遗留有缺损和畸形的患者需行Ⅱ期整复术。     

口腔颌面部大动物抓咬伤患者的护理

对5例口腔颌面部大动物抓咬伤患者行清创缝合术及皮瓣移植术,结果除1例组织缺损严重,患者Ⅰ期手术植皮区瘢痕愈合而行Ⅱ期整复外,其余4例均为Ⅰ期愈合.提出加强心理护理、口腔护理和饮食护理,预防供受区感染;以及加强术后皮瓣护理,细心观察皮瓣血液循环,防止皮瓣区受压,预防皮瓣感染等措施是口腔颌面部大动物抓咬伤护理成功的关键.     

医用胶在儿童颌面部犬咬伤治疗中的应用

目的探讨医用胶在儿童颌面部犬咬伤治疗中的应用效果。方法 2015年1月～2016年12月就诊于我院急诊外科的颌面部犬咬伤患儿120例,随机分为两组,各60例,予常规清创、免疫及抗感染治疗后,观察组予医用胶处理伤口,对照组采用常规缝合法处理伤口。比较两组的治疗操作时间、创面感染率、愈合有效率、瘢痕形成和愈后患者满意度。结果两组感染率和创面愈合有效率无明显差异(P 0. 05),观察组操作时间和瘢痕形成VSS评分显著低于对照组,患者满意度明显优于对照组(P 0. 05)。结论采用医用胶处理儿童颌面部犬咬伤创面可减少手术操作时间和后期瘢痕形成,显著提高患者满意度。     

口腔颌面部大动物抓咬伤患者的护理

5例口腔颌面部大动物抓咬伤患者行清创缝合术及皮瓣移植术，结果除1例组织缺损严重，患者Ⅰ期手术植皮区瘢痕愈合而行Ⅱ期整复外，其余4例均为Ⅰ期愈合。提出加强心理护理、口腔护理和饮食护理，预防供受区感染；以及加强术后皮瓣护理，细心观察皮瓣血液循环，防止皮瓣区受压，预防皮瓣感染等措施是口腔颌面部大动物抓咬伤护理成功的关键。     

儿童颌面部犬咬伤的美容外科修复

目的：探讨美容外科原则在儿童颌面部犬咬伤-临床处理中的应用。方法：回顾性总结并分析2005年3月～2008年3月烧伤与修复重建外科对21例儿童颌面部犬咬伤伤口早期清创处理及整复手术治疗的临床资料。结果：所有病例均未发生狂犬病。伤口Ⅰ期Ⅱ／甲级愈合19例;Ⅱ期愈合2例。Ⅰ期愈合病例,伤口瘢痕达到良好的整复效果。结论：在儿童颌面部犬咬伤伤口早期处理过程中应用美容外科原则进行整复是安全可行的。     

一期缝合联合脂质水胶敷料引流在颌面部犬咬伤治疗中的应用效果

目的探讨一期缝合联合脂质水胶敷料引流在颌面部犬咬伤治疗中的应用效果。方法 2015年1月~2016年12月我院急诊外科收治360例颌面部犬咬伤患者,随机均分为两组:实验组180例,其中颧区49例,颊区38例,腮腺咬肌区41例,颏区24例,眶下区28例;对照组180例,其中颧区43例,颊区39例,腮腺咬肌区45例,颏区33例,眶下区20例。均伤口清创后均予以一期缝合,实验组采用脂质水胶敷料进行创口引流,对照组无引流。观察比较两组的创面感染率、愈合时间、有效率和瘢痕形成情况。结果实验组患者的伤口感染率及瘢痕形成VSS评分均明显低于对照组,愈合时间明显短于对照组,治疗7 d和14 d后总有效率显著高于对照组,差异均有统计学意义(P0.05)。结论一期缝合颌面部犬咬伤创面治疗中应用脂质水胶敷料引流能够加速创面愈合,减少感染率和瘢痕的形成。     

应用皮瓣一期修复犬咬伤致皮肤缺损1例

随着现代社会宠物饲养的增多,被犬咬伤的患者也逐渐增多。通常犬咬伤后创面因为污染重,经清创后伤口常采取延期缝合,有时皮肤缺损面积大常采用植皮封闭,创面愈合时间长,瘢痕重。我们对1例前臂犬咬伤皮肤缺损达10cm×8cm的患者,采用早期彻底清创局部皮瓣转移一期修复创面,     

儿童颌面部狗咬伤的综合治疗

目的:探讨儿童颌面部狗咬伤的临床综合治疗效果。方法:对2002年至2006年我院收治颌面部狗咬伤患儿38例,给予清创缝合及药物治疗。结果:38例患者中,伤口均行一期缝合处理,伤口一期愈合36例,一期愈合率94.7%,未发现1例患儿患狂犬病。结论:儿童颌面部狗咬伤治疗时应及时、正确、合理地处治伤口,正确应用免疫药物及抗生素,促进伤口愈合,才能有效的预防狂犬病发生。     

美容整形清创缝合术联合重组人表皮生长因子治疗颌面部外伤

目的:探讨美容整形清创缝合术联合重组人表皮生长因子治疗颌面部外伤的临床疗效。方法:选取2013年12月-2015年10月笔者所在医院收治的110例颌面部外伤患者作为研究对象,随机分成治疗组和对照组,各55例。其中对照组患者采取常规外科缝合技术进行清创缝合,治疗组患者采用美容整形清创缝合术联合重组人表皮生长因子进行清创缝合,比较两组患者创口愈合时间及瘢痕恢复情况。结果:治疗组患者治疗的总有效率为96.4%,对照组为76.4%,治疗组患者临床疗效明显高于对照组;治疗组患者愈合时间为(4.51±2.01)d,对照组为(7.72±2.02)d;与对照组患者相比,明显缩短了治疗组患者愈合时间,具有显著差异(P0.05)。结论:美容整形清创缝合术联合重组人表皮生长因子对于颌面部外伤患者具有较好的临床疗效,缩短伤口愈合时间,避免瘢痕的形成。     

颌面部软组织开放性创伤的治疗

目的:正确处理开放性伤口,预防瘢痕过度生长或瘢痕疙瘩的形成。方法:对118例颌面部软组织开放性伤口采用清创、技巧性缝合、药物消肿等措施进行治疗。结果:所有患者的伤口均为Ⅰ期愈合。结论:正确把握开放性伤口治疗过程的每一个环节,即能最大限度的预防瘢痕过度生长或瘢痕疙瘩的形成。     

Facial Dog Attack Injuries

The exposed position of the face makes it vulnerable to dog bite injuries. This fact combined with the short stature of children makes them a high-risk group for such attacks. In contrast to wounds inflicted by assaults and accidents, dog bite wounds are deep puncture type wounds compounded by the presence of pathologic bacteria from the saliva of the attacking dog. This, combined with the presence of crushed, devitalized tissue makes these wounds highly susceptible to infection. Key to successful management of such wounds are meticulous cleansing of the wound, careful debridement, primary repair, appropriate antibiotic therapy, and rabies and tetanus immunization where indicated. This review presents an overview of the epidemiology, presentation, management of such emergencies, and the recent advances in the care of such patients.     

Occult craniocerebral injuries from dog bites in young children

Although dog bite injuries to the head and scalp of children occur frequently, penetrating dog bite wounds to the cranial vault occur only occasionally and may go unnoticed on initial examination. Substantial morbidity and mortality can ensue if these penetrating injuries are not detected and treated. The authors detail the evaluation of dog bites of the scalp in young children. They highlight the ease with which puncture wounds of the calvarium may be missed during physical examination as a result of scalp displacement at the time of puncture. The cranial puncture may not be large and may later be covered by scalp that returns to its native position. Well-scrutinized skull films and a careful, methodical physical examination are advocated. Recognized craniocerebral injuries should be explored. Depressed cranial fractures should be irrigated, debrided, and elevated. Dural tears should be repaired. Expedient management is necessary to prevent meningitis and its associated sequelae.     

Scrotal dog bites

PURPOSE: Dog bites to the scrotum are rare but they potentially result in morbidity if improperly managed. MATERIALS AND METHODS: Between 1991 and 1999 we treated 4 men and 3 boys with dog bites to the scrotum. All 7 patients presented to the emergency department shortly after the injury. Of the 4 adults 3 were ingesting alcohol and 2 were obviously intoxicated, and 1 had a T4 spinal cord injury and was bitten during sleep. Of the children 2 were apparently bitten without provocation, while a 5-year-old boy was bitten when the family dog was disturbed while eating. RESULTS: All wounds were explored, irrigated and débrided. There was no involvement of the testes or spermatic cord. Each wound was closed primarily and 5 healed without sequelae. The spinal cord injured man had partial dehiscence of the incision and in another man superficial hematoma required drainage. Each patient received antibiotics and tetanus prophylaxis but none required rabies inoculation. CONCLUSIONS: Although there are reports of devastating scrotal injuries from dog bites, most such wounds may be treated by careful inspection for intrascrotal injuries followed by débridement and closure. Antimicrobial prophylaxis should be administered, as for any bite wound.     

Bite wound infections of the lower extremity

Animal bite wounds of the lower extremity are considered high-risk wounds for infection, especially in the medically compromised individual. Management should be aggressive. Copious irrigation and debridement of the wound clearly proves to be of greater value in the prevention of infection than the indiscriminate use of so-called "prophylactic" antibiotic agents. Frankly infected wounds must also be managed aggressively, incorporating the use of antibiotics to eradicate the infection. Empiric use of an agent containing clavulanic acid or sulbactam is suggested until results are obtained from the bacterial culture and sensitivity. Tetanus prophylaxis should be considered for every bite wound, whereas rabies prophylaxis is warranted in selected cases.     

Surgical delay in the management of dog bite injuries in children,does it increase the risk of infection?

Dog bites are contaminated wounds and convention dictates that any surgical treatment should be performed at the earliest opportunity. This practice, however, may be in direct conflict with NCEPOD guidelines to reduce night time operating. We audited our treatment of dog bite injuries in children over a 5-year period (1998-2002) to determine whether delaying surgery to conform to operating guidelines increased the incidence of infection. A retrospective case note study identified 118 patients admitted to Sheffield Children's Hospital with dog bite injuries. Details of their injury, treatment and outcome were recorded. There were 70 males and 48 females and an average age of 6.6 years (range 1-15 years). The most common type of injury was a single laceration (32%) and the most frequent site of injury was the face (59%). The majority of wounds (68%) were cleaned and dressed before theatre and 89% were closed directly after minimal debridement. All patients received prophylactic antibiotics. Of the 114 patients that required surgery, 57 (50%) were operated on within 12 h of their injury and 57 (50%) after 12 h. There were three cases of infection in the early group (<12 h) and none in the delayed group (>12 h). We suggest that delaying the surgical treatment of dog bites in children to avoid operating at night does not increase the infection rate.     

The therapy of genital trauma by dog bite

Genital trauma by dog bite rarely is reported. We present 2 cases of dog bite to the external genitalia involving male infants. Rabies precautions, tetanus prophylaxis and antimicrobial therapy are reviewed. Both children required surgical debridement and split thickness skin grafts for repair. Since pediatric genital trauma may be the result of negligence or even deliberate abuse, a thorough investigation of the child's environment is mandatory in such situations.     

Animal bites, active and reserve components, U.S. Armed Forces, 2001-2010

From 2001 to 2010, there were 20,522 diagnoses of animal bites among U.S. military members. Of these, 643 (3.1%) were documented during medical encounters in combat theater. The majority of bites were "dog bites" and occurred more in males, soldiers, and those in infantry and law enforcement occupations. A small proportion of animal bites received documentation of exposure to or post-exposure prophylaxis for rabies virus. Animal bite avoidance and rabies education should be reinforced before members travel or deploy to areas highly endemic for rabies.     

Cat And Dog Bites. What To Do?

Inroduction: Domestic animal bites are quite common, but mostly cause minor lesions, for which no medical help is sought. The objective of this study is to define the complications resulting from cat and dog bites that lead to hospital admission. This analysis led to updated guidelines for the treatment of dog and cat bites in humans. Patients and methods: The emergency department (ED) data of our hospital for the year 2004 were retrospectively analysed, seeking patients that presented with bite wounds from either cat or dog. The patient files were reviewed. Results: 34 patients, bitten by cats or dogs, presented to our ED in 2004. 73.5% of them (n = 25) consulted within 24 hours after the bite. In 11 of these patients (44.0%), primary closure of the wound was performed after thorough rinsing and evaluation of the dead space. All these patients were given prophylactic antibiotics. In none of these did the wounds need to be reopened afterwards. Nine patients (26.5%) did not present to the ED until after the day they were bitten. In all these patients, the bite wounds were located on the hand (n = 6) or forearm (n = 3). They all consulted because of complications. The main symptoms were limited and there was painful mobilisation of fingers and wrist, and swelling and redness in the area of the bite wound. Their wounds were thoroughly explored and in 6 of these nine late-presenting patients, a tendon lesion or a purulent flexor tenosynovitis was diagnosed. These six patients needed admission for further management. The mean admission duration was 6 days (range 4 to 10 days). None of the admitted patients showed any signs of limited mobility or disability during follow-up after discharge. Conclusion: While cat and dog bites often cause minor lesions that can be treated by thorough wound care if presented early, the importance of possible late complications should not be overlooked. Patients that present with the symptoms of tissue infection due to a cat or dog bite should be examined adequately and may need admission. Due to aggressive treatment, we had no serious or disabling complications in our population after discharge.     

Hundebissverletzungen des Gesichtes bei Kindern

When children are bitten by dogs, the face and neck region is more often involved than in adults. Injuries of this localisation are of special importance, regarding their cosmetic and functional impact. The mainstay of paediatric surgical treatment of facial dog bites is primary wound excision and wound closure under general anaesthesia. The high risk of infection should be addressed to by prophylactic administration of antibiotics if necessary and local wound treatment. Rabies and tetanus infections can be ruled out by an adequate vaccination status of the child and dog prior to the injury. Simultaneous active and passive vaccination becomes necessary when any doubt arises about the vaccination status of the child (tetanus) or of the dog (rabies).