Wundheilung nach schwersten Knochen- und Weichgewebsverletzungen - Fallbeispiele und Therapiemanagement

In Europe and in the USA, approx. 175 to 740 bite injuries per 100,000 inhabitants occur. Among the animal bites 90% are dog bites, which happen mostly before age of 10 years with a maximum between 5 and 9 years. While in adults dog bites are most often on the limbs, in children the face is involved in up to 78%. The necessity of surgical treatment depends on the severity of the injury. The typical characteristic of a dog bite is the high masticatory force of 50 - 100 kg per qcm, leading large areas of avital tissue. These masticatory forces lead to typical injury patterns ranging from superficial wounds to severe tissue defects including bone. Infected bite injuries generally should additionally be treated by i.v. antibiotics. Until the microbiological test result is present, treatment with beta-lactamase-resistant penicillin or combinations (e. g. amoxicillin and clavulan acid) is recommended. Extensive, long-lasting flushing of the wound with high intensity, eventually with pressure, is indicated. In general, maximum tissue preservation in the face is indicated. In the face, a primary wound closure after extensive cleaning of the wound is regarded as indicated. We report on two 2 yrs old children, who both suffered from severe dog-bites by major periorbital lacerations including the eye-lid apparatus, lacrimal drainage system, disruption of the left malar bone and NOE fractures. In one patient the mandible was bit through and the great cervical vessel exposed. The management of these severe injuries is demonstrated showing the advantage of an interdisciplinary approach to reconstruct the patients primarily. In both patients primary wound healing occured. Schlagwörter: Bissverletzung, Gesichtsverletzung, Traumatologie