HEAD AND NECK INJURIES DUE TO ANIMAL ATTACKS: OUR CLINICAL EXPERIENCES

Öz

Purpose: Head and neck injuries may end up with physical, functional and psychological problems besides persistent facial deformities. This study aimed to review the management of patients who were admitted to our department due to animal attack to head and neck region

Material and Method: Sixteen patients who were admitted to Ankara Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Department between 2006-2018 due to animal attack to head and neck region and managed by surgical intervention were included in this study. Demographic features, type of injuries and type of surgical managements are reviewed in here.

Results: Twenty four lesions of sixteen patients were operated. Mean age of the patients was 18.8 (3-64) and female/male ratio was 2.2/1. Most of the patients were injured due to dog attack (10/16) while others were due to donkey, bear and horse attack in order of frequency.  The most injured part was perioral region (8/24) while scalp (5/24), malar (5/24), periorbital (2/24), nasal (2/24), ear (1/24) and neck (1/24) region were the others. There were fractures in three patients and fractures were found to be statistically significantly higher in adult patients compared to children (p=0.036). Seventeen of the injuries were managed by direct suturation, while six were treated with local flaps and one by free flap.

Conclusion: Current management strategy in animal attacks to head and neck region consists of early management, irrigation and debridement of the wound followed by primary repair of the lesion, as prefered in the current study. The patients attacked especially by large animals should be evaluated for the presence of fractures. Primary repair, rational use of antibiotics, tetanus and rabies prophylaxis, all together seem to be effective with the least complication rates in this group of patients.

Anahtar Kelimeler

• Head,neck,animal,attack,bite

HAYVAN SALDIRISINA BAĞLI BAŞ VE BOYUN BÖLGESİ YARALANMALARI: KLİNİK DENEYİMLERİMİZ

Öz

Amaç: Baş ve boyun bölgesinin yaralanmaları, fiziki, işlevsel ve psikolojik problemlere ve kalıcı yüz deformitelerine neden olabilir. Bu yazıda, farklı hayvan saldırılarına bağlı baş ve boyun bölgesinde defekt nedeni ile kliniğimize başvuran hastaların değerlendirilmesi ve deneyimlerin paylaşması amaçlanmıştır.

Gereç ve Yöntem: Bu çalışmaya, Ankara Eğitim ve Araştırma Hastanesi, Plastik Rekonstrüktif ve Estetik Cerrahi Kliniği’ ne 2006-2018 tarihleri arasında hayvan saldırısına bağlı baş ve boyun bölgesi yaralanması nedeniyle başvuran ve rekonstrüksiyon için cerrahi müdahale ihtiyacı olan 16 hasta dahil edilmiştir. Hastaların demografik özellikleri, yaralanma biçimleri ve uygulanan cerrahi tedaviler değerlendirilmiştir.

Bulgular: Çalışmaya dahil edilen 16 hastada 24 bölge onarımı yapıldı. Hastaların yaş ortalaması 18,8 (3-64 yaş) ve Kadın / Erkek oranı 2,2/1 idi. Kliniğimize en sık köpek saldırısına bağlı hastalar başvururken (10/16), eşek, ayı ve at saldırısına maruz kalmış hastalar azalan sıklıkla bu grubu izlemekteydi.  En fazla onarım yapılan bölge perioral (8/24), sonrasında azalan sıklık oranlarına göre skalp  (5/24), malar (5/24), periorbital (2/24), burun (2/24), kulak (1/24) ve boyun (1/24) bölgesi idi. Hastaların 3 tanesinde fraktür izlenmiş ve erişkin hastalarda çocuk hastalara göre daha fazla fraktür olduğu görülmüştür (p=0.036). Tüm yaralanmaların 17 si direkt sütürasyonla yapılırken, 6 sı lokal fleplerle ve 1 tanesi de serbest flep ile onarıldı.

Sonuç: Hayvan saldırılarına bağlı baş boyun bölgesi yaralanmalarında güncel yaklaşım, bu çalışmada da tercih edildiği gibi erken müdahale edilmesi ve irrigasyon ve debridmanını takiben  primer onarım yönündedir. Büyük hayvan yaralanmalarında hastalar fraktür açısından değerlendirilmelidir. Komplikasyon oranları da dikkate alındığında, primer kapama, akılcı antibiyotik kullanımı, kuduz ve tetanoz profilaksisi bu grup hastada etkin gözükmektedir.

Anahtar Kelimeler

• Baş,boyun,hayvan,saldırısı,ısırık

Kaynakça

1. 1. Weiss HB, Friedman DI, Coben JH. Incidence of dog bite injuries treated in emergency departments. JAMA 1998; 279: 51-3.
2. 2. Gelvez M, Enrique R, Gajos G, Bladimir J, Carvajal D, Luis A. Animal and human bite injuries: a 5-year retrospective study in a large urban public hospital in Venezuela. Oral Maxillofac Surg 2017; 21: 425-28.
3. 3. Gurunluoglu R, Glasgow M, Arton J, Bronsert M. Retrospective analysis of facial dog bite injuries at a Level I trauma center in the Denver metro area. J Trauma Acute Care Surg 2014; 76: 1294-300.
4. 4. Centers for Disease Control and Prevention. http://www.cdc.gov/ HomeandRecreationalSafety/Dog-Bites/dogbite-pubs.html, Accessed July 2013.
5. 5. Aziz H, Rhee P, Pandit V, Tang A, Gries L, Joseph B. The current concepts in management of animal (dog, cat, snake, scorpion) and human bite wounds. J Trauma Acute Care Surg 2015; 78: 641-8.
6. 6. Mannion CJ, Graham A, Shepherd K, Greenberg D. Dog bites and maxillofacial surgery: what can we do? Br J Oral Maxillofac Surg 2015; 53: 522-5.
7. 7. Wolff KD. Management of animal bite injuries of the face: experience with 94 patients. J Oral Maxillofac Surg 1998; 56: 838-43; discussion 43-4.
8. 8. Rothe K, Tsokos M, Handrick W. Animal and Human Bite Wounds. Dtsch Arztebl Int 2015; 112: 433-42.

9. 9. Edwards MS. Animal and Human Bites. In: Long SS, Pickering LK, Prober CG; eds. Principles and Practice of Pediatric Infectious Diseases. 4th ed.: Philadelphia, Elsevier, 2012.p.3570-9
10. 10. Chaudhry MA, Macnamara AF, Clark S. Is the management of dog bite wounds evidence based? A postal survey and review of the literature. Eur J Emerg Med 2004; 11: 313-7.
11. 11. Wu PS, Beres A, Tashjian DB, Moriarty KP. Primary repair of facial dog bite injuries in children. Pediatr Emerg Care 2011; 27: 801-3.
12. 12. Stefanopoulos PK, Tarantzopoulou AD. Facial bite wounds: management update. Int J Oral Maxillofac Surg 2005; 34: 464-72.
13. 13. Sezgin B, Ljohiy M, Akgol Gur ST. Animal-inflicted open wounds in rural Turkey: lessons learned and a proposed treatment algorithm for uncertain scenarios. Int Wound J 2016; 13: 1282-88.
14. 14. Ginsburg CM, Hunstad DA. Animal and Human Bites. In: Kliegman RM, Stanton B, St.Geme J, and Schor NF; eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, Elsevier, 2015.p.3447-50.
15. 15. Zhang QB, Zhang B, Zhang ZQ, Chen Q. The epidemiology of cranio-facial injuries caused by animals in southern-central China. J Craniomaxillofac Surg 2012: 40: 506-9.
16. 16. Tiemdjo HG, Coulibaly T, Toure AA. Paediatric open tibiofibular fractures following a donkey bite. A report of two cases. Orthop Traumatol Surg Res 2009; 95: 314-8.
17. 17. Meyers B, Schoeman JP, Goddard A, Picard J. The bacteriology and antimicrobial susceptibility of infected and non-infected dog bite wounds: fifty cases. Vet Microbiol 2008; 127: 360-8.
18. 18. McHeik JN, Vergnes P, Bondonny JM. Treatment of facial dog bite injuries in children: a retrospective study. J Pediatr Surg 2000; 35: 580-3.
19. 19. Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med 1999; 340: 85-92.
20. 20. Cummings P. Antibiotics to prevent infection in patients with dog bite wounds: a meta-analysis of randomized trials. Ann Emerg Med 1994; 23: 535-40.
21. 21. Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. Cochrane Database Syst Rev 2001; CD001738.