Javaid M, Feldberg L, Gipson M
Department of Plastic Surgery, Whiston Hospital, Prescot, Merseyside, UK.
J R Soc Med. 1998 Aug;91(8):414-6. doi: 10.1177/014107689809100804.
Dog bites to the face can be life-threatening if major infection occurs, and traditional management consists of wound toilet and debridement, with repair only when the possibility of infection has been eliminated. Surgical opinion is now swinging towards earlier repair. We have analysed retrospectively the outcome of 40 cases that, irrespective of time delay between injury and presentation, underwent primary repair or reconstruction after wound toilet, debridement and administration of prophylactic antibiotics. The victims were 17 males and 23 females with ages ranging from 2 to 76 years (mean 25). Median delay between the injury and presentation in the emergency department was 60 minutes (range 7 minutes to 5 days). All patients received surgical treatment within 24 hours of admission, 18 being operated on within 6 hours. 31 had primary repairs and 9 patients had reconstructive procedures with local skin flaps or skin grafts. Primary healing was achieved in all but 2 patients, of whom one developed minor wound infection and one had necrosis of a composite graft. These results support the view that, for dog bites to the face, primary repair is the method of choice.
犬类咬伤面部若发生严重感染可能危及生命，传统治疗方法包括伤口清理和清创，只有在感染风险消除后才进行修复。目前外科观点正倾向于早期修复。我们回顾性分析了40例患者的治疗结果，这些患者无论受伤与就诊之间的时间间隔长短，均在伤口清理、清创及给予预防性抗生素后接受了一期修复或重建手术。受害者中男性17例，女性23例，年龄从2岁至76岁不等（平均25岁）。受伤至在急诊科就诊的中位时间间隔为60分钟（范围7分钟至5天）。所有患者均在入院后24小时内接受了手术治疗，其中18例在6小时内接受了手术。31例行一期修复，9例患者采用局部皮瓣或皮肤移植进行重建手术。除2例患者外，其余均实现一期愈合，其中1例发生轻微伤口感染，1例复合移植组织出现坏死。这些结果支持以下观点，即对于犬类咬伤面部，一期修复是首选方法。
