Objective: To evaluate the effectiveness of double pedicled flap and technique of geometric broken line (GBL) for primary repair of serious dog bite wound.
Methods: Between 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.
Results: All 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.
Conclusions: It 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.
目的: 探讨下颌缘双蒂皮瓣联合创缘几何形破裂线（geometric broken line，GBL）设计一期修复面颊部严重犬咬伤的疗效。.
方法: 2006年10月-2014年12月，收治9例面颊部严重犬咬伤患者。男3例，女6例；年龄8～68岁，平均34.5岁。伤后至入院时间30 min～24 h，平均4 h。创面缺损范围1.7 cm×0.5 cm～15.0 cm×8.0 cm；深度达0.3～0.8 cm，平均0.5 cm；合并深部组织外露。入院后彻底清创、持续封闭式负压引流（vacuum sealing drainage，VSD）及灌洗1 d后行创面修复。术中修剪面颊缺损内上方创缘，设计成以矩形和直角为主的GBL，并在缺损外下方设计与之对应的创缘GBL；然后在缺损外下方设计并切取大小为1.7 cm×1.5 cm～18.0 cm×15.0 cm的双蒂皮瓣修复创面。供区直接拉拢缝合。术后继续VSD治疗3 d。.
结果: 术后患者皮瓣均顺利成活，创面Ⅰ期愈合。供区切口Ⅰ期愈合，瘢痕隐蔽。患者均获随访，随访时间6个月～8年，平均4年。患者面部外形满意，未遗留明显瘢痕。随访期间无狂犬病发作。.
结论: 下颌缘双蒂皮瓣联合创缘GBL设计可一期修复面部严重犬咬伤，获得满意美容效果。.
Keywords: Dog bite wound; Double pedicled flap; Face; Geometric broken line.