Paschos Nikolaos K, Makris Eleftherios A, Gantsos Apostolos, Georgoulis Anastasios D
Department of Trauma and Orthopaedic Surgery, University of Ioannina, Ioannina, Greece; Department of Biomedical Engineering, University of California, Davis, CA, USA.
Injury. 2014 Jan;45(1):237-40. doi: 10.1016/j.injury.2013.07.010. Epub 2013 Aug 2.
Dog bite wounds represent a major health problem. Despite their importance, their management and especially the role of primary closure remain controversial. In this randomised controlled trial, the outcome between primary suturing and non-closure was compared.
168 consecutive patients with dog bite injuries were included in this study. The wounds were allocated randomly in two treatment approaches: Group 1, consisting of eighty-two patients, had their wound sutured, whilst Group 2, consisting of eighty-six patients, did not have their wounds sutured. All wounds were cleansed using high-pressure irrigation and povidone iodine. All patients received the same type of antibiotic treatment. Our measured outcomes included presence of infection and cosmetic appearance. Cosmetic outcome was evaluated using the Vancouver Scar Scale (VSS). Wound and patient characteristics, such as time of management, wound location and size, and patient age, were recorded and analysed for their potential role in the resulting outcome.
The overall infection rate was 8.3%. No difference in the infection rate between primary suturing and non-suturing group was detected in the present study. The cosmetic appearance of the sutured wounds was significantly better (mean score 1.74) compared to the wounds that were left open (mean score 3.05) (p=0.0001). The infection rate was comparable among all age groups. Wounds treated within 8h of injury demonstrated an infection rate of 4.5%, which is lower compared to the 22.2% rate observed in wounds treated later than 8h. The wounds located at the head and neck exhibited better results in both infection rate and cosmetic outcome. Additionally, wounds >3 cm negatively affected the cosmetic appearance of the outcome.
Primary suturing of wounds caused by dog bites resulted in similar infection rate compared to non-suturing. However, primary suturing exhibited improved cosmetic appearance. Time of management appeared to be critical, as early treatment resulted in lower infection rate and improved cosmetic appearance regardless suturing or not. Furthermore, wounds located at the head and face demonstrated better results.
犬咬伤伤口是一个重大的健康问题。尽管其很重要，但对其处理，尤其是一期缝合的作用仍存在争议。在这项随机对照试验中，比较了一期缝合与不缝合的结果。
本研究纳入了168例连续的犬咬伤患者。伤口被随机分配到两种治疗方法中：第1组由82例患者组成，其伤口进行了缝合，而第2组由86例患者组成，其伤口未进行缝合。所有伤口均使用高压冲洗和聚维酮碘进行清洁。所有患者接受相同类型的抗生素治疗。我们测量的结果包括感染情况和外观。使用温哥华瘢痕量表（VSS）评估外观结果。记录并分析伤口和患者特征，如处理时间、伤口位置和大小以及患者年龄，以了解它们在最终结果中的潜在作用。
总体感染率为8.3%。本研究未检测到一期缝合组与未缝合组之间的感染率差异。与未缝合的伤口（平均评分为3.05）相比，缝合伤口的外观明显更好（平均评分为1.74）（p = 0.0001）。所有年龄组的感染率相当。受伤后8小时内处理的伤口感染率为4.5%，低于受伤后8小时后处理的伤口观察到的22.2%的感染率。位于头颈部的伤口在感染率和外观结果方面均表现出更好的效果。此外，大于3 cm的伤口对结果的外观有负面影响。
犬咬伤伤口的一期缝合与不缝合相比，感染率相似。然而，一期缝合的外观有所改善。处理时间似乎至关重要，因为早期治疗无论是否缝合都能降低感染率并改善外观。此外，位于头面部的伤口效果更好。
