摘要
目的探讨头面部犬咬伤后暴露伤口行一期缝合手术的安全性和临床效果。方法2015年10月至2018年10月甘肃省第二人民医院整形外科收治了42例头面部犬咬伤创面Ⅲ级暴露患者,男性22例,女性20例,年龄1~81岁。首先以弱碱性冲洗液冲洗创面、彻底清创,11岁以下患儿只注射狂犬疫苗,其他患者同时注射破伤风抗毒素1500 IU,在创面周围浸润注射狂犬病人免疫球蛋白(20 IU/kg)后行一期缝合手术,术后以倍舒痕(Dermatix)抗瘢痕治疗至少1年。术后观察创面愈合和并发症发生情况,对面部有无畸形、双侧是否对称进行随访,并采用温哥华瘢痕量表(VSS)评估瘢痕。结果42例中38例(90.4%)甲级愈合;2例(4.8%)乙级愈合,其中1例深度在肌层的下颌部伤口,术后10 d在颈部出现深部脓肿,穿刺引流后治愈;2例(4.8%)丙级愈合。32例患者在术后2~5 d有不同程度的发热,体温在38.5℃以下,1~2 d后体温恢复正常。术后随访6~24个月,所有病例均未发生破伤风和狂犬病。术后1~2年随访时,42例中1例术后1年左右面颊部不对称,1例术后1年上睑有瘢痕,睁眼时双眼不对称;40例双侧面部对称,无张口、睁眼和闭眼功能障碍,面部形态恢复满意,VSS评分在1~3分。结论对于头面部犬咬伤暴露伤口,根据狂犬病预防处置规范处理后行一期缝合手术,在预防狂犬病的同时,可有效预防患者面部畸形和严重瘢痕的形成,是安全有效的治疗方式。
Objective To evaluate the safety and clinical efficacy of primary suturing of dog bite injuries on the head and face.Methods A total of 42 cases with the dog bite injuries of GradeⅢrabies exposure on the head and face(20 females and 22 males,aged from 1 to 81)were enrolled from October 2015 to October 2018 at the Department of Plastic Surgery,The Second People’s Hospital of Gansu Province.The primary suturing was performed after meticulous wound debridement and sufficient irrigation,the patients who were under 11 years old only received rabies vaccine for the rabies post-exposure prophylaxis,whereas the others were reinforced with tetanus antitoxin(1500 IU)and human rabies immunoglobulin(20 IU/kg)around the wound,followed by Dermatix anti-scarring treatment for at least one year.Post-operative observation included wound healing and potential complications.All patients were followed up for facial deformities and bilateral symmetry,and the scars were assessed using the Vancouver Scar Scale(VSS).Results Among the 42 cases,38 cases(90.4%)were Class-A healed,2 cases(4.8%)were Class-B healed(one of the two cases had a mandibular wound deep in the muscular layer.A deep abscess appeared in the neck 10 days after surgery,and was cured after puncture and drainage),and 2 cases(4.8%)were Class-C healed.Thirty-two patients had fever to different extent 2 to 5 days after surgery,and their body temperatures were below 38.5℃.The body temperature returned to normal after 1 to 2 days.During 6-24 months of follow-up,no tetanus and rabies occurred in all cases.During 1 to 2 years of follow-up,1 of 42 cases had asymmetrical cheek 1 year post-operation.1 case had scars on the upper eyelid 1 year after operation,and both eyes were asymmetric when eyes were open.Other 40 cases were recovered with bilateral symmetry without dysfunction of opening and closing the mouth and eyes.Facial contour recovery was cosmetically satisfactory with VSS score 1-3.Conclusions Primary suturing of dog bite injuries on the head and face,according to the rabies prevention and treatment guideline,is a safe and effective treatment.It prevents rabies,and facial deformities and severe scar deformity in patients.
作者
王永翔
马淑娟
燕晓姣
谢斐
Wang Yongxiang;Ma Shujuan;Yan Xiaojiao;Xie Fei(Department of Plastic Surgery,the Second People’s Hospital of Gansu Province,Lanzhou 730030,China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2020年第6期645-649,共5页
Chinese Journal of Plastic Surgery
关键词
头部
面部
犬
咬伤
一期缝合
Head
Face
Dogs
Bites and stings
Sutures
