犬咬伤的急诊处理与美容修复  

Emergency treatment and cosmetic repair of bite wound by dog

作　　者：刘毅[1] 刘萍[1] 宋玫[1] 肖斌[1] 陈黎明[1] 姜疆[1] 徐承新[1] 孙晓晨[1] 

机构地区：[1]兰州军区兰州总医院全军烧伤整形外科中心,甘肃兰州730050

出　　处：《中国美容医学》2012年第12期2125-2128,共4页Chinese Journal of Aesthetic Medicine

摘　　要：目的:总结犬咬伤急诊处理与美容修复的经验。方法:对2010年1月至2012年8月,治疗的51例119处犬咬伤伤口急诊处理效果进行回顾性分析。遵照医学美学和整形美容外科原则和技术,采用新的缝合技术分层严密缝合,针距和边距0.2～0.3cm;若有皮肤软组织缺损,按照"宁近勿远,宁简勿繁"原则,选择全厚皮片或各种皮瓣修复;强调延期修复,注重康复治疗。结果:51例119处伤口,清创后直接缝合37处,全厚皮片移植23处,各种皮瓣修复29处;延期修复30处,直接缝合5处,局部皮瓣25处。111处伤口Ⅰ期愈合,愈合率93.3%;伤口对合良好,无明显瘢痕和器官移位与变形。Ⅰ期修复的8处伤口愈合欠佳,经换药或二次手术愈合。37例84个部位经3～12个月随访,外观良好,瘢痕增生轻微,5处移植皮片存在不同程度的色素沉着,2例患者眉部分缺失,1例耳郭部分缺失,1例面神经瘫痪。结论:犬咬伤急诊处理中,遵照"创伤美容修复"理念,充分运用美学理论和整形美容外科技术,实施及时准确的治疗,就能实现美容修复的目标。对不具备一期修复的伤口应延期修复。Objective To summarize the experience of emergency treatment and cosmetic repair of bite wound by dog. Methods The curative effects of 119 wounds from 51 cases of bite wound by dog, to be treated from January 2010 to August 2012, were analyzed retrospectively. The principles of medical aesthetics and plastic and cosmetic surgery were followed. A wound without skin and soft tissue defect was sutured accurately according to tissue zonation with a new suture technique, and the needle distance or side distance was limited in 0.2cm to 0.3cm. Otherwise, the wound was repaired by full-thickness skin graft or various flaps according to the principle of ＂rather near than further, rather simple than complicated＂. Delayed repair was emphasized. It was pay attention to rehabilitation care. Results After debridement, 37 wounds were sutured directly, 23 wounds were repaired by full-thickness skin grafting and 29 wounds by various flaps. 111wounds healed on the first stage, and the healing rate reached 9313%. The wounds were in satisfactory apposition and without obvious cicatrix. Any organs didn＇t appear in malposition and deformity. Eight wounds which were repaired on the first stage didn＇t heal, and they were repaired by changing dressings or second operations. 84 wounds from 37 cases were followed up. The results showed good appearance and slight cicatrix hyperplasia, a pigmentation in different degree appeared in five wounds covered by skin grafting. In addition, partial excalation of eyebrow or auricle appeared in 3 cases, and facial neuralgia in one case. Conclusion During treating emergency cases of bite wound by dog, if an idea ＂ cosmetic repair of trauma＂ is followed, the theory of aesthetics and the techniques of plastic and cosmetic surgery are fully used, and a prompt and accurate treatment is put into practice, the aim of cosmetic repair could be come true. In addition, with those wounds, which couldn＇t be repaired on the first stage, delayed repair would be employed.

关 键 词：动物咬伤 急救 创面修复 美容学 犬 

分 类 号：R622[医药卫生—整形外科]