Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind; Department of Medicine, Division of Cardiology, Indiana University School of Medicine, Indianapolis, Ind.
J Vasc Surg. 2013 Nov;58(5):1346-52. doi: 10.1016/j.jvs.2013.05.101. Epub 2013 Jul 24.
Vascular trauma from large-dog bites present with a combination of crush and lacerating injuries to the vessel, as well as significant adjacent soft tissue injury and a high potential for wound complications. This retrospective case series evaluates our 15 years of experience in managing this uncommonly seen injury into suggested treatment recommendations.
From our database, 371 adult patients presented with dog bites between July 1997 and June 2012. Twenty (5.4%) of those patients had vascular injuries requiring surgical intervention. Patient demographics, anatomic location of injury, clinical presentation, imaging modality, method of repair, and complication rates were reviewed to assess efficacy in preserving limb function. Pediatric patients were managed at the regional children's hospital and, therefore, not included in this study.
Among the 20 surgically treated vascular injuries, there were 13 arterial-only injuries, two venous-only injuries, and five combination arterial and venous injuries. Seventeen patients (85%) had upper extremity injuries; three patients had lower extremity injuries (15%). The axillobrachial artery was the most commonly injured single vessel (n = 9/20; 45%), followed by the radial artery (n = 4/20; 20%). Surgical repair of vascular injuries consisted of resection and primary anastomosis (four), interposition bypass of artery with autogenous vein (13), and ligation (two), with (one) being a combination of bypass and ligation. All patients had debridement of devitalized tissue combined with pulse lavage irrigation and perioperative antibiotics. Associated injuries requiring repair included muscle and skin (n = 10/20; 50%), bone (n = 1/20; 5%), nerve (n = 1/20; 5%), and combinations of the three (n = 5/20; 25%). Postoperative antibiotic therapy was administered for 14.7 ± 8.2 days in all 20 patients. Four patients (20%) developed postoperative wound infections, although this did not compromise their vascular repair. Of the patients compliant with postoperative surveillance, all limbs (100%) were viable at discharge and at 1-year follow-up.
Dog bite vascular injuries are an uncommon occurrence, where extremity pulse abnormalities are the most common presentation. These injuries are also associated with significant adjacent soft tissue trauma, which warrants aggressive debridement and perioperative antibiotic therapy. Despite vigilant management, nearly one-fifth of our patients sustained wound infections. All infections were successfully managed with broad-spectrum antibiotics, and all limbs were preserved 1-year postoperatively.
大型犬咬伤导致的血管创伤，既有对血管的挤压和撕裂伤，也有明显的相邻软组织损伤，而且伤口并发症的风险很高。本回顾性病例系列研究评估了我们 15 年来治疗这种罕见损伤的经验，并提出了治疗建议。
从我们的数据库中，1997 年 7 月至 2012 年 6 月期间，有 371 名成年患者因狗咬伤就诊。其中 20 名（5.4%）患者需要手术干预治疗血管损伤。回顾患者的人口统计学特征、损伤的解剖部位、临床表现、影像学检查方法、修复方法和并发症发生率，以评估保留肢体功能的效果。儿科患者在地区儿童医院接受治疗，因此未纳入本研究。
在 20 例接受手术治疗的血管损伤中，有 13 例为单纯动脉损伤，2 例为单纯静脉损伤，5 例为动静脉联合损伤。17 例（85%）为上肢损伤，3 例（15%）为下肢损伤。最常受伤的单一血管是腋肱动脉（n = 9/20；45%），其次是桡动脉（n = 4/20；20%）。血管损伤的手术修复包括切除和端端吻合（n = 4）、自体静脉间置旁路（n = 13）和结扎（n = 2），其中（n = 1）是旁路和结扎的联合。所有患者均行失活组织清创术，并联合脉冲灌洗冲洗和围手术期抗生素治疗。需要修复的其他合并损伤包括肌肉和皮肤（n = 10/20；50%）、骨骼（n = 1/20；5%）、神经（n = 1/20；5%）和三者的组合（n = 5/20；25%）。20 例患者的术后抗生素治疗时间为 14.7 ± 8.2 天。4 例（20%）患者发生术后伤口感染，但并未影响血管修复效果。在接受术后监测的患者中，所有肢体（100%）在出院时和 1 年随访时均存活。
狗咬伤导致的血管损伤并不常见，其最常见的表现是肢体脉搏异常。这些损伤还伴有明显的相邻软组织损伤，需要积极清创和围手术期抗生素治疗。尽管进行了密切管理，但我们近五分之一的患者仍发生了伤口感染。所有感染均通过广谱抗生素成功治疗，所有肢体在术后 1 年均得以保留。
