Roy Mélissa, Plant Mathew A, Snell Laura
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Arch Plast Surg. 2018 Jan;45(1):80-84. doi: 10.5999/aps.2016.01991. Epub 2017 Oct 27.
Although uncommon, shark attacks can lead to devastating outcomes for victims. Surgeons also face unique challenges during operative management such as exsanguination, shock, specific injury patterns and infections. This case report presents the management of a 39-year-old previously healthy female attacked by a shark while on vacation in Mexico. The patient sustained severe injuries to her left arm and her left thigh. She was transferred to a Canadian institution after ambiguous operative management in Mexico and presented with no clear antibiotic coverage and a Volkman's contracture of the left upper extremity. In total, the patient underwent four washouts of wounds, two split-thickness skin grafts, one free anterolateral thigh flap, and one free transverse rectus abdominus myocutaneous flap for the reconstruction and salvage of the left lower extremity. This article highlights the specifics of this case and describes important points in managing these devastating injuries.
虽然鲨鱼袭击并不常见，但对受害者来说可能会导致毁灭性的后果。外科医生在手术处理过程中也面临着独特的挑战，如出血、休克、特定的损伤模式和感染。本病例报告介绍了一名39岁、此前身体健康的女性在墨西哥度假时遭到鲨鱼袭击后的治疗情况。患者的左臂和左大腿受到严重损伤。在墨西哥进行了不明确的手术处理后，她被转至一家加拿大机构，当时没有明确的抗生素覆盖治疗，并且左上肢出现了Volkmann挛缩。该患者总共接受了四次伤口冲洗、两次中厚皮片移植、一次游离股前外侧皮瓣移植以及一次游离腹直肌肌皮瓣移植，以重建和挽救左下肢。本文重点介绍了该病例的具体情况，并描述了处理这些毁灭性损伤的要点。
