From the Plastic and Reconstructive Surgery (R.G., J.A.), and Oral Maxillofacial Surgery (M.G.), Denver Health Medical Center, University of Colorado Health Sciences Center, Denver; and Colorado Health Outcomes Program (COHO) (M.B.), University of Colorado, Aurora, Colorado.
J Trauma Acute Care Surg. 2014 May;76(5):1294-300. doi: 10.1097/TA.0000000000000185.
Facial dog bite injuries pose a significant public health problem.
Seventy-five consecutive patients (45 males, 30 females) treated solely by plastic surgery service for facial dog bite injuries at a Level I trauma center in the Denver Metro area between 2006 and 2012 were retrospectively reviewed. The following information were recorded: breed, relationship of patient to dog, location and number of wounds, the duration between injury and surgical repair and dog bite incident, type of repair, and antibiotic prophylaxis. Primary end points measured were wound infection, the need for revision surgery, and patient satisfaction.
Ninety-eight wounds in the head and neck region were repaired (46 children; mean age, 6.8 years) and (29 adults; mean age, 47.3 years). Twelve different breeds were identified. There was no significant association between the type of dog breed and the number of bite injuries. The duration between injury and repair ranged from 4 hours to 72 hours (mean [SD], 13.7 [10.9] hours). The majority of bite wounds (76 of 98) involved the cheek, lip, nose, and chin region. Direct repair was the most common surgical approach (60 of 98 wounds) (p < 0.05). There was no statistically significant association between wounds needing reconstruction versus direct repair according to dog breed (p = 0.25). Ten wounds required grafting. Twenty-five wounds were managed by one-stage or two-stage flaps. Only three patients (3.06 %) underwent replantation/revascularization of amputated partial lip (n = 2) and of cheek (n = 1). There was one postoperative infection. Data from five-point Likert scale were available for fifty-two patients. Forty patients were satisfied (5) with the outcome, while five patients were somewhat satisfied (4), and seven were neutral.
Availability of the plastic surgery service at a Level I trauma center is vital for the optimal treatment of facial dog bite injuries. Direct repair and reconstruction of facial dog bite injuries at the earliest opportunity resulted in good outcomes as evidenced by the satisfaction survey data and low complication rate.
Therapeutic study, level V. Epidemiologic study, level III.
面部狗咬伤是一个重大的公共卫生问题。
在 2006 年至 2012 年期间，在丹佛都会区一级创伤中心，仅由整形外科服务治疗的 75 例连续面部狗咬伤患者（45 名男性，30 名女性）进行了回顾性研究。记录了以下信息：品种、患者与狗的关系、伤口的位置和数量、受伤和手术修复之间的时间以及狗咬伤事件、修复类型和抗生素预防。主要终点测量是伤口感染、需要修正手术和患者满意度。
修复了头部和颈部区域的 98 个伤口（46 例儿童；平均年龄 6.8 岁）和（29 例成人；平均年龄 47.3 岁）。确定了 12 个不同品种。狗的品种与咬伤数量之间没有显著关联。受伤和修复之间的时间从 4 小时到 72 小时不等（平均[标准差]为 13.7[10.9]小时）。大多数咬伤伤口（98 个中的 76 个）涉及脸颊、嘴唇、鼻子和下巴区域。直接修复是最常见的手术方法（60 个伤口）（p <0.05）。根据狗的品种，需要重建的伤口与直接修复之间没有统计学上的显著关联（p = 0.25）。10 个伤口需要植皮。25 个伤口采用一期或两期皮瓣治疗。只有 3 名患者（3.06%）接受了部分嘴唇（2 例）和脸颊（1 例）截肢再植/再血管化。有 1 例术后感染。52 名患者中有 5 名提供了五点李克特量表数据。40 名患者对结果满意（5），5 名患者有些满意（4），7 名患者中立。
一级创伤中心提供整形外科服务对于面部狗咬伤的最佳治疗至关重要。尽早进行直接修复和重建面部狗咬伤可获得良好的结果，这一点从满意度调查数据和低并发症率可以证明。
治疗研究，等级 V；流行病学研究，等级 III。
