Carlson Jacob T, Yuen James C, Smeds Matthew R
University of Arkansas for Medical Sciences, Department of General Surgery, 4301 W. Markham St., Little Rock, AR 72205, United States.
University of Arkansas for Medical Sciences, Department of Plastic Surgery, 4301 W. Markham St., Little Rock, AR 72205, United States.
Trauma Case Rep. 2017 Mar 14;9:5-9. doi: 10.1016/j.tcr.2017.01.009. eCollection 2017 Jun.
Animal bites are fairly rare events but can cause devastating traumatic injuries to the victim. In addition to the soft tissue, vascular, and orthopedic trauma inflicted by these occurrences, bite injuries also have the potential to introduce an inoculum of microbes, which may progress to an infection if not treated properly and expeditiously. We present the case of a healthy male who sustained multiple bite wounds from a domestic zebra to his left upper extremity. This attack caused severe damage, including devascularization of the arm at the brachial artery, disruption of the distal biceps and brachialis, stripping of the forearm nerves, and shearing of the overlying soft tissue. The patient was taken emergently to the operating room for revascularization of the extremity utilizing a vein bypass graft. The soft tissue injuries were addressed with numerous irrigation and debridement procedures, during which coverage of the vein bypass graft was obtained using a variety of techniques, including skin flaps, musculocutaneous advancements, and the application of an acellular dermal matrix (AlloDerm) and a collagen-glycosaminoglycan matrix (Integra). Wound cultures obtained intra-operatively during the irrigation and debridement procedures were notable for the growth of multiple microbes, including spp., which have been documented to cause infection in immunocompromised patients. The patient in this case was treated with a prolonged course of antibiotics, and wound cultures negative for microbial growth were eventually obtained prior to final closure of his wound. The patient then underwent successful biceps reconstruction with a pedicled latissimus dorsi muscle transfer. This case documents the extraordinary multidisciplinary approach provided in the salvage, management, and eventual reconstruction of a mangled left upper extremity that had sustained devastating traumatic injuries resulting from a rather unusual source.
动物咬伤是相当罕见的事件，但会给受害者造成毁灭性的创伤。除了这些事件造成的软组织、血管和骨科创伤外，咬伤还可能引入微生物接种物，如果不及时妥善治疗，可能会发展为感染。我们报告一例健康男性被家养斑马咬伤左上肢多处的病例。这次袭击造成了严重损伤，包括肱动脉处手臂血管离断、肱二头肌远端和肱肌断裂、前臂神经剥离以及覆盖的软组织剪切伤。患者紧急被送往手术室，通过静脉搭桥术进行肢体血管重建。软组织损伤通过多次冲洗和清创处理，在此过程中，采用了多种技术覆盖静脉搭桥移植物，包括皮瓣、肌皮推进以及应用脱细胞真皮基质（AlloDerm）和胶原 - 糖胺聚糖基质（Integra）。在冲洗和清创过程中术中获取的伤口培养物显示有多种微生物生长，包括 菌属，这些微生物已被证明可在免疫功能低下的患者中引起感染。该病例患者接受了长时间的抗生素治疗，最终在伤口最终闭合前获得了微生物生长阴性的伤口培养结果。然后患者通过带蒂背阔肌转移成功进行了肱二头肌重建。本病例记录了在抢救、处理以及最终重建严重受损的左上肢时所采取的非凡多学科方法，该上肢因相当不寻常的原因遭受了毁灭性创伤。
