Zieliński Tomasz
Klinika Chirurgii Plastycznej, Rekonstrukcyjnej i Estetycznej UM w Łodzi.
Otolaryngol Pol. 2010 May-Jun;64(3):157-60. doi: 10.1016/S0030-6657(10)70052-4.
Biting of humans by domestic animals, especially by dogs, is common injury which causes suffering and pain, might be a cause of disability or even death. It is associated with high risk of bacterial infection of the wounds or even transfection of rabies virus. Bites are usually to the upper and lower limbs, while the face is third in a raw localization of bites. Within the face, the nose and lips are injured the most often. The goal of this paper is presentation selected methods and obtained results of primary closure of dog bite injures of the nose.
There were 16 patients with dog bites injures of the nose treated in the Department of Plastic, Reconstructive and Aesthetic Surgery of the Medical University of Łódź in the years 2003-2008. The patients were 11 to 46 years old. Bites caused either superficial laceration of the skin, tearing of the nostril wing or even major defects of the tissues.
In 7 patients superficial wounds a direct closure was done and antibiotic ointment was applied. In 7 patients a defect of the skin was covered with a skin graft taken from retroauricular area, but in 2 of the patients of this group repair of mucosa and alar cartilage was done. In two persons with full thickness defects of the nose reconstruction was performed with the use of a pedicled nosolabial flap. Complications occurred only in 1 patient who developed infection in the wound. In all other patients there were no complications. Good aesthetic results were obtained.
Primary closure approach of bite injures with tissue defect is not associated with larger risk than in the case in secondary such approach, and should be implemented always whenever it is possible in order to avoid risk of wound and scars which require further reconstructive procedures in future.
家畜咬人,尤其是狗咬伤人类,是一种常见的伤害,会导致痛苦和疼痛,可能致残甚至致死。它还伴有伤口细菌感染甚至狂犬病病毒传播的高风险。咬伤部位通常在上肢和下肢,而面部是咬伤部位的第三高发区域。在面部,鼻子和嘴唇最常受伤。本文的目的是介绍对狗咬伤鼻子的一期缝合的选定方法及取得的结果。
2003年至2008年期间,罗兹医科大学整形、重建与美容外科收治了16例狗咬伤鼻子的患者。患者年龄在11岁至46岁之间。咬伤导致皮肤浅表撕裂、鼻翼撕裂甚至组织严重缺损。
7例浅表伤口患者进行了直接缝合并涂抹了抗生素软膏。7例皮肤缺损患者采用取自耳后区域的皮肤移植覆盖,但该组中有2例患者还进行了黏膜和鼻翼软骨修复。2例全层鼻缺损患者采用带蒂鼻唇瓣进行了重建。仅1例患者出现并发症,即伤口感染。所有其他患者均未出现并发症,获得了良好的美学效果。
对于伴有组织缺损的咬伤采用一期缝合方法与二期缝合相比,风险并不更大,只要有可能,应始终采用一期缝合,以避免伤口和瘢痕风险,否则未来可能需要进一步的重建手术。