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头颈部动物咬伤损伤的重建

Reconstruction of animal bite injuries to the head and neck.

作者信息

Mendoza Joshua M, Chi John J

机构信息

Washington University School of Medicine.

Department of Otolaryngology - Head and Neck Surgery, Division of Facial Plastic & Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.

出版信息

Curr Opin Otolaryngol Head Neck Surg. 2019 Oct;27(5):407-412. doi: 10.1097/MOO.0000000000000564.

Abstract

PURPOSE OF REVIEW

The aim if this review is to provide an update on the existing literature of animal bite treatment strategies and provide a systematic approach to animal bites from presentation to reconstruction.

RECENT FINDINGS

Dog bites cause 80-90% of animal bites with 26.8-56.5% occurring in the head and neck. Infection rates may be as low as 5.7-9.7%. Primary closure alone is sufficient in 69.8% of dog bites within the first 24 h.

SUMMARY

Animal bite injuries to the head and neck are common, especially in the younger population. Dogs cause a majority of these bite injuries. Injuries can include simple lacerations or punctures, avulsions with tissue present, or avulsions with loss of tissue. The most common locations are the cheek, nose, and lips. It is important to gather the vaccination status of the animal and patient and to administer tetanus/rabies prophylaxis if indicated. Antibiotics are typically prescribed for 3-5 and 7-14 days for uninfected and infected wounds, respectively. These wounds require evaluation, irrigation, and occasionally debridement or repair in the operating room. The type of repair is determined based on the location and extent of injury and can range from primary closure to microsurgical replantation, skin grafts, flaps, or even facial transplantation.

摘要

综述目的

本综述旨在更新动物咬伤治疗策略的现有文献,并提供一种从就诊到重建的系统性动物咬伤处理方法。

最新发现

狗咬伤占动物咬伤的80%-90%,其中26.8%-56.5%发生在头颈部。感染率可能低至5.7%-9.7%。在伤后24小时内,69.8%的狗咬伤仅进行一期缝合就足够了。

总结

头颈部的动物咬伤很常见,尤其是在年轻人群中。大多数此类咬伤是由狗造成的。损伤可包括单纯裂伤或刺伤、伴有组织的撕脱伤或伴有组织缺失的撕脱伤。最常见的部位是脸颊、鼻子和嘴唇。收集动物和患者的疫苗接种情况并在必要时给予破伤风/狂犬病预防措施很重要。对于未感染和感染的伤口,抗生素通常分别使用3-5天和7-14天。这些伤口需要评估、冲洗,偶尔还需要在手术室进行清创或修复。修复类型根据损伤的部位和程度而定,范围从一期缝合到显微外科再植、皮肤移植、皮瓣,甚至面部移植。

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