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

Yıl 2019, Cilt: 52 Sayı: 2, 101 - 107, 31.07.2019

Koray Gürsoy , Galip Gencay Üstün , Fethiye Berna Göktaş Demircan Uğur Koçer

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

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