Rothe M, Rudy T, Stanković P
Klinik für Unfallchirurgie, Plastische und Wiederherstellungschirurgie, Klinikum der Georg-August-Universität Göttingen, Germany.
Handchir Mikrochir Plast Chir. 2002 Jan;34(1):22-9. doi: 10.1055/s-2002-22103.
Animal bites make up a large proportion of the injuries treated in an emergency department. Due to the type of injury, the variety of wounds and the contamination with aerobic and anaerobic organisms, they deserve special attention. In this study, we reviewed 98 patients (55 male/43 female) with bite wounds to the hand and wrist treated between 1995 and 2000. They were either treated conservatively (n = 65) or surgically (n = 33) depending on the clinical findings. In 18 of 33 cases, the reason for surgical treatment was an infection. A primary antibiotic prophylaxis, usually with cephalosporines, was administered in 47 of 98 cases. Results were analysed retrospectively. An infection developed in 32 patients. In six of these patients, an infection developed despite primary antibiotic prophylaxis. Operative treatment became necessary in four of these six cases. Twenty-six of 32 patients were treated without primary antibiotic prophylaxis. Surgical treatment was required in around half (n = 14) of these patients, while the other 12 patients were treated conservatively with antibiotic therapy.Twenty-one of 26 patients presented with bite wounds that were already infected. Microbiological examination revealed a variety of microbes, usually a mixed infection with Pasteurella multocida was found. All organisms were susceptible to treatment with second or third generation cephalosporines.A total of 15 patients had to be operated due to deeper injuries to the bone, extensive soft-tissue injury, or because of injury to a tendon and the tendon sheath. In most patients, a good to acceptable functional result was achieved. Primary antibiotic prophylaxis does not prevent the development of infection. Nevertheless, because of the inherently high infection risk associated with bite wounds to the hand and wrist, prophylaxis should be carried out. In case of severe damage to the soft tissue or signs of infection, early surgical therapy should be considered.
动物咬伤在急诊科治疗的损伤中占很大比例。由于损伤类型、伤口种类以及需氧菌和厌氧菌的污染情况，这类咬伤值得特别关注。在本研究中，我们回顾了1995年至2000年间接受治疗的98例手部和腕部咬伤患者（男55例/女43例）。根据临床检查结果，他们要么接受保守治疗（n = 65），要么接受手术治疗（n = 33）。在33例手术治疗的患者中，有18例的手术原因是感染。98例患者中有47例接受了通常为头孢菌素类的一级抗生素预防治疗。对结果进行了回顾性分析。32例患者发生了感染。其中6例患者尽管接受了一级抗生素预防治疗仍发生了感染。这6例患者中有4例需要进行手术治疗。32例感染患者中有26例未接受一级抗生素预防治疗。这些患者中约一半（n = 14）需要手术治疗，而另外12例患者接受了抗生素保守治疗。26例患者中有21例就诊时咬伤伤口已被感染。微生物学检查发现了多种微生物，通常为多杀巴斯德菌混合感染。所有微生物对第二代或第三代头孢菌素治疗均敏感。共有15例患者因骨骼深度损伤、广泛软组织损伤或肌腱及腱鞘损伤而必须接受手术。大多数患者获得了良好至可接受的功能结果。一级抗生素预防不能预防感染的发生。然而，由于手部和腕部咬伤本身感染风险高，仍应进行预防。如果软组织严重受损或有感染迹象，应考虑早期手术治疗。
