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再植困境:从一位 16 岁女孩狗咬伤前臂离断伤处理中获得的经验教训。

Replantation dilemma: lessons learned from managing a dog bite forearm amputation in a sixteen-year-old girl.

机构信息

Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy.

出版信息

Eur Rev Med Pharmacol Sci. 2024 Aug;28(16):4149-4155. doi: 10.26355/eurrev_202408_36667.

Abstract

BACKGROUND

Bite injuries, particularly those involving the hands, present a significant medico-legal challenge, often leading to complications and frequent emergency department visits. Dog and cat bites, especially among children, are major contributors to infections due to the complex anatomy of the hand, which predisposes it to severe infections even from minor bites. Capnocytophaga canimorsus, found in the oral cavity of dogs and cats, is particularly concerning due to its potential to cause severe infections. Prompt and appropriate treatment is essential to mitigate these risks. Managing such injuries poses significant challenges, necessitating clear guidelines for reporting and safety measures. This article highlights the urgent need for additional research, support, and education, particularly focusing on children, along with the development of international guidelines to improve outcomes for patients.

CASE REPORT

A case study of a sixteen-year-old girl who had her left forearm amputated due to a rottweiler bite is presented. Despite initial attempts at replantation, complications led to the decision for amputation.

CONCLUSIONS

This case underscores the challenges in managing severe dog bite injuries, emphasizing the importance of prompt assessment, thorough debridement, and proper wound management to minimize complications. Additionally, psychological evaluation and treatment are crucial for patients and parents following such traumatic events. From a medical standpoint, this case highlights the importance of monitoring inflammatory markers, appropriate surgical priorities, and the need for psychological support. Prevention of dog bites is crucial, requiring increased awareness among public authorities and dog owners. Clear guidelines for reporting dog bites are essential, but further research is needed to improve their comprehensiveness and effectiveness.

摘要

背景

咬伤,特别是手部咬伤,带来了重大的医学法律挑战,往往导致并发症和频繁的急诊就诊。狗和猫咬伤,尤其是儿童,是导致感染的主要原因,因为手部的复杂解剖结构,即使是轻微的咬伤也容易导致严重感染。口腔中存在的嗜二氧化碳噬纤维菌,由于其可能导致严重感染,因此尤为令人关注。及时和适当的治疗对于减轻这些风险至关重要。处理此类伤害带来了重大挑战,需要有明确的报告和安全措施指南。本文强调了迫切需要更多的研究、支持和教育,特别是针对儿童,同时制定国际指南以改善患者的预后。

病例报告

本文介绍了一例 16 岁女孩因罗威纳犬咬伤导致左前臂截肢的病例。尽管最初尝试再植,但并发症导致了截肢的决定。

结论

该病例突显了管理严重狗咬伤的挑战,强调了及时评估、彻底清创和适当的伤口管理对于最小化并发症的重要性。此外,对患者和家长进行心理评估和治疗也至关重要。从医学角度来看,该病例强调了监测炎症标志物、适当的手术优先级以及心理支持的重要性。预防狗咬伤至关重要,需要公共当局和狗主人提高认识。明确的狗咬伤报告指南至关重要,但需要进一步研究以提高其全面性和有效性。

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