Differentiated approach to the surgical tactics choice in the treatment of patients with bite wounds

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Abstract

Background. Wounds inflicted by the teeth of animals and humans take a special place and have a number of characteristic features. There is still no generally accepted surgical tactics for the bite wounds treatment, and the issues of choosing the timing of wound closure, depending on their localization, remain unresolved.

Aim. To analyze the clinical experience of bite wounds surgical treatment by applying primary and secondary sutures.

Material and methods. From 2008 to 2018 409 patients with bite wounds of various localizations (289 female and 120 male) aged 16 to 84 years were under our supervision. The average age of the victims was 52.5±10.17 years. All patients were prescribed combined therapy, which was based on an urgent surgical care, since we attach a decisive role in the prevention and local treatment of wound infection to full primary or secondary surgical treatment. The analysis of the obtained data was performed using the statistical calculations in R 3.6.3 (R Foundation for Statistical Computing). To compare the average treatment time for primary and secondary sutures nonparametric Mann–Whitney test was used.

Results. Analysis of the obtained clinical data showed that the largest number of bite wounds were dog bites (95%), which occured most often in spring (38%) and summer (38.1%), and, as a rule, at home (68%), these results were comparable with statistical data from other sources. The average duration of patients’ treatment with a primary suture was 13.2 days, and with a secondary suture — 19.3 days. The authors proposed a differentiated approach to the choice of surgical tactics in the treatment of patients with bite wounds, depending on the timing of their admission to the hospital and the local status of the wound defect.

Conclusion. The primary or primary delayed blind suturing should be used in the early stages (not later than in 12 hours after getting a bite), and secondary sutures are shown in late stages (more than 12 hours).

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About the authors

Sergey G. Izmailov

City Clinical Hospital No. 7 named after E.L. Berezova

Email: izi28082009@yandex.ru
ORCID iD: 0000-0001-7998-9277

M.D., Doct.Sci. (Med.), Prof.

Russian Federation, Nizhny Novgorod, Russia

Andrey E. Leontiev

City Clinical Hospital No. 7 named after E.L. Berezova

Email: leontjeff@mail.ru
ORCID iD: 0000-0001-6510-3391

M.D., Cand.Sci. (Med.), Assoc.Prof.

Russian Federation, Nizhny Novgorod, Russia

Alexander G. Izmailov

Kazan State Medical University

Author for correspondence.
Email: izmailov_alex@mail.ru
ORCID iD: 0000-0001-9559-550X
Russian Federation, Kazan, Russia

Egor E. Lukoyanychev

City Clinical Hospital No. 7 named after E.L. Berezova

Email: egor-lukoyanychev@yandex.ru
ORCID iD: 0000-0001-6392-2692

M.D., Cand.Sci. (Med.), Assoc.Prof.

Russian Federation, Nizhny Novgorod, Russia

Andrey I. Rotkov

City Clinical Hospital No. 7 named after E.L. Berezova

Email: 3959400@mail.ru
ORCID iD: 0000-0002-6678-8422

M.D., Cand.Sci. (Med.), Assoc.Prof.

Russian Federation, Nizhny Novgorod, Russia

Anatoly A. Kuranov

City Clinical Hospital No. 7 named after E.L. Berezova

Email: aa.kuranov@gmail.com
ORCID iD: 0000-0001-6899-5890

M.D., Cand.Sci. (Med.)

Russian Federation, Nizhny Novgorod, Russia

Nikita A. Koloshein

City Clinical Hospital No. 7 named after E.L. Berezova

Email: n.koloshein@mail.ru
ORCID iD: 0000-0002-4563-5478

M.D., Depart. of Purulent Surgery

Russian Federation, Nizhny Novgorod, Russia

Andrey V. Mezinov

City Clinical Hospital No. 7 named after E.L. Berezova

Email: mezinov.andre@yandex.ru

M.D., Head, Depart. of Purulent Surgery

Russian Federation, Nizhny Novgorod, Russia

Anton S. Simonov

City Clinical Hospital No. 7 named after E.L. Berezova

Email: anton_simonov91@mail.ru
ORCID iD: 0000-0002-3377-5860

M.D., Depart. of Purulent Surgery

Russian Federation, Nizhny Novgorod, Russia

Evgeny V. Samarin

City Clinical Hospital No. 7 named after E.L. Berezova

Email: samar-evgenij@yandex.ru

M.D., Depart. of Traumatology and Orthopedics

Russian Federation, Nizhny Novgorod, Russia

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1. Рис. 1. Общая характеристика получения травмы

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2. Рис. 2. Локализация и сроки лечения укушенных ран; по оси абсцисс — р при сравнении сроков лечения с использованием первичных и вторичных швов при различных локализациях

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