目的 总结严重犬咬伤三级暴露伤口感染的处置及护理经验。 方法 对2010年1月－2012年10月收治的30例下肢严重犬咬伤三级暴露患者，及时采用流动清水冲洗，局部麻醉，复方黄柏液纱条换药等处置方法，并对患者及家属进行心理疏导和饮食指导，使患者的犬伤得到有效控制和治疗。 结果 30 例患者无狂犬病发生， 25例伤口Ⅰ期愈合， 5例伤口延缓Ⅱ期愈合，双下肢活动自如，患者及家属满意。 结论 正确处理伤口和规范全程疫苗接种及精心护理是控制伤口感染，减轻患者疼痛，促进伤口最佳愈合、预防人狂犬病发生的重要因素。
目的:分析犬伤暴露后到我院犬伤门诊就诊病例的流行病学相关因素,为制定狂犬病的防治策略提供科学依据。方法:采用描述性统计方法根据犬伤门诊记录,对就诊患者的年龄、性别、发病时间、暴露级别、伤口处理、疫苗接种和犬伤Ⅲ度暴露者狂犬免疫球蛋白的接种及伤人犬只情况等相关因素进行统计。结果:2008年我院犬伤门诊共接诊2 589例,咬伤人犬只的接种率为46.26 %。就诊病例的年龄有两个高峰,分别是0～10岁组和21～30岁组。就诊时间除1～2月和11～12月病例较少外,全年各月份均在198～342人之间。犬伤暴露后,只有2.16 %病例及时、正确地处理了伤口。100%的犬伤暴露者进行了狂犬疫苗的注射。犬伤Ⅲ度暴露中,狂犬免疫球蛋白的使用仅为28.4%。结论:加强犬类动物的管理,对家犬实行免疫,加强对低年龄组儿童的保护。做好狂犬病的防治和知识的宣传工作,合理设置犬伤医学门诊。加大政府投入力度提供全程、免费接种服务。
ObjectiveTo evaluate the effectiveness of double pedicled flap and technique of geometric broken line (GBL) for primary repair of serious dog bite wound. MethodsBetween October 2006 and December 2014, 9 patients with serious dog bite wound were treated. There were 3 males and 6 females with an average age of 34.5 years (range, 8-68 years), and with a mean disease duration of 4 hours (range, 30 minutes to 24 hours). The defect ranged from 1.7 cm×0.5 cm to 15.0 cm×8.0 cm, with the mean depth of 0.5 cm (range, 0.3-0.8 cm). Deep tissue exposure was observed. After routine debridement, a vacuum sealing drainage (VSD) was equipped to suck and irrigate for 1 day, then wound was repaired. The superomedial edge of defect was trimmed, then a GBL shape mainly with square and rectangular was designed. According to defect size, a double pedicled flap was designed at the lateroinferior edge of defect, which size ranged from 1.7 cm×1.5 cm to 18.0 cm×15.0 cm. The donor site was sutured directly. VSD was used for 3 days after operation. ResultsAll flaps survived and wound healed, and donor site incision healed well, with invisible scar. All patients were followed up 6 months to 8 years (mean, 4 years). The wounds were repaired well, and the patients had good facial appearance. No rabies attack was observed during follow-up. ConclusionIt is an ideal repair method to chose double pedicled flap and technique of GBL for primary repair of dog bite wounds. Satisfactory cosmetic appearance can be obtained.