初級縫合: 傷口經初步清理後直接縫合
延遲初級縫合: 汙染較嚴重或感染率較高的傷口, 經過清洗清創之後, 觀察數天(一般是72小時)視傷口狀況評估是否縫合
一般傷口建議12小時內縫合(臉部24小時內)
受傷超過12小時以上的傷口不建議初級縫合, 可選擇延遲初級縫合
內容來自 uptodate:Animal bites (dogs, cats, and other mammals): Evaluation and management
以下中文使用google翻譯
傷口縫合 — 對於大多數咬傷傷口未感染的患者，我們建議讓傷口保持開放，透過次級縫合而非初級縫合自行癒合(流程圖 1和圖 2 )。
對於臉部撕裂傷（包括貓咬傷）較大，影響美觀，或軀幹、手臂或腿部（不是手或腳）被狗咬傷，且傷口較大，且符合以下所有標準的患者，初級縫合是合理的選擇：
●未感染的傷口
●免疫功能正常的患者
●近期咬傷（四肢咬傷時間少於 12 小時，臉部咬傷時間少於 24 小時）
●無擠壓傷或刺傷
●患肢無蜂窩性組織炎或靜脈/淋巴系統損害病史
對於可能受益於初級縫合但存在上述禁忌症之一的傷口，患者可開始預防性抗生素治療，並計劃在3-4日後進行延遲初級縫合。除非臨床醫生在延遲初級縫合方面經驗豐富，否則建議轉診至外科醫生或其他傷口專家，因為縫合時可能需要額外清創（例如，清除過多積聚的肉芽組織）。
咬傷傷口縫合方法的選擇（即初級縫合, 次級縫合或延遲初級縫合）應根據傷口性質、沖洗和清創是否能合理清潔傷口以及宿主的免疫狀態進行個體化選擇。
以下中文使用google翻譯
傷口縫合 — 對於大多數咬傷傷口未感染的患者，我們建議讓傷口保持開放，透過次級縫合而非初級縫合自行癒合(流程圖 1和圖 2 )。
對於臉部撕裂傷（包括貓咬傷）較大，影響美觀，或軀幹、手臂或腿部（不是手或腳）被狗咬傷，且傷口較大，且符合以下所有標準的患者，初級縫合是合理的選擇：
●未感染的傷口
●免疫功能正常的患者
●近期咬傷（四肢咬傷時間少於 12 小時，臉部咬傷時間少於 24 小時）
●無擠壓傷或刺傷
●患肢無蜂窩性組織炎或靜脈/淋巴系統損害病史
對於可能受益於初級縫合但存在上述禁忌症之一的傷口，患者可開始預防性抗生素治療，並計劃在3-4日後進行延遲初級縫合。除非臨床醫生在延遲初級縫合方面經驗豐富，否則建議轉診至外科醫生或其他傷口專家，因為縫合時可能需要額外清創（例如，清除過多積聚的肉芽組織）。
咬傷傷口縫合方法的選擇（即初級縫合, 次級縫合或延遲初級縫合）應根據傷口性質、沖洗和清創是否能合理清潔傷口以及宿主的免疫狀態進行個體化選擇。
初級縫合可加速癒合並減少不良美容後果 [ 1,22,44,52-55 ]。然而，對於小傷口和刺傷，初級縫合可能增加的感染風險通常超過其最小的美容益處 [ 24 ]。臉部傷口是例外，因為與其他解剖部位相比，臉部傷口更有利於美容，且感染率較低 [ 1,44,49-51 ]。延遲初級縫合期間的等待期可使宿主的防禦系統減少細菌負荷，並確保不會發生感染，而感染是縫合的禁忌症。
我們同意美國傳染病學會 (IDSA) 對大多數病例的指南（例如，反對對非臉部貓咬傷進行初級縫合）[ 1 ]。然而，儘管 IDSA 不建議對非面部犬咬傷進行初級縫合，但我們同意其他專家的觀點，他們支持對軀幹、手臂或腿部（但不包括手和腳）的犬咬傷造成的撕裂傷進行初級縫合[ 46,47 ]。研究發現，初級縫合傷口不會增加此類咬傷的感染風險，反而與改善美容效果有關[ 44,46,47 ]。然而，手部傷口、刺傷或延遲出現的傷口（例如，受傷後 > 8 小時）的初級縫合與感染率增加相關[ 24,44,46 ]。
Wound closure — For most patients with uninfected bite wounds, we suggest that the wounds be left open to heal by secondary intention rather than by primary closure (algorithm 1 and figure 2). (See "Minor wound evaluation and preparation for closure", section on 'Type of closure'.)
Primary closure is a reasonable alternative in a patient with a facial laceration (including a cat bite) that is sufficiently large to affect cosmesis or a gaping dog bite on the trunk, arm, or leg (not on a hand or foot) who meets all of the following criteria:
●Uninfected wound
●Immunocompetent patient
●Recent bite (<12 hours old for bites on an extremity, <24 hours old for facial bites)
●No crush injury or puncture wound
●No prior episode of cellulitis or venous/lymphatic compromise on the affected extremity
For a wound that may benefit from primary closure but has one of these contraindications, the patient may be started on prophylactic antibiotics with a plan for delayed primary closure after three to four days. Unless the clinician has extensive experience with delayed primary closure, referral to a surgeon or other wound expert is advised since additional debridement (eg, of excessive accumulated granulation tissue) may be necessary at the time of closure. (See "Minor wound evaluation and preparation for closure", section on 'Delayed primary closure'.)
The choice of bite wound closure (ie, primary closure, healing by secondary intention, or delayed primary closure) should be individualized to the nature of the wound, whether irrigation and debridement can reasonably clean the wound, and the immune status of the host. Primary closure hastens healing and reduces adverse cosmetic outcomes [1,22,44,52-55]. However, for small wounds and puncture wounds, the potentially increased risk of infection from primary closure typically outweighs the minimal cosmetic benefit [24]. Facial wounds are an exception given increased cosmetic consequences and a lower rate of infection compared with other anatomic sites [1,44,49-51]. The waiting period during delayed primary closure permits the host defense system to decrease bacterial load and to ensure that no infection develops, which is a contraindication to closure.
We agree with the Infectious Diseases Society of American (IDSA) guidelines for most cases (eg, against primary closure of nonfacial cat bites) [1]. However, even though the IDSA recommends against primary closure of nonfacial dog bites, we agree with other experts who favor primary closure of lacerations due to dog bites on the trunk, arms, or legs (though not on the hands or feet) [46,47]. Studies have found that primary wound closure does not increase the risk of infection in such bites but is associated with improved cosmetic outcomes [44,46,47]. However, primary closure of hand wounds, puncture wounds, or wounds with delayed presentations (eg, >8 hours since injury) is associated with an increased rate of infection [24,44,46].
我們同意美國傳染病學會 (IDSA) 對大多數病例的指南（例如，反對對非臉部貓咬傷進行初級縫合）[ 1 ]。然而，儘管 IDSA 不建議對非面部犬咬傷進行初級縫合，但我們同意其他專家的觀點，他們支持對軀幹、手臂或腿部（但不包括手和腳）的犬咬傷造成的撕裂傷進行初級縫合[ 46,47 ]。研究發現，初級縫合傷口不會增加此類咬傷的感染風險，反而與改善美容效果有關[ 44,46,47 ]。然而，手部傷口、刺傷或延遲出現的傷口（例如，受傷後 > 8 小時）的初級縫合與感染率增加相關[ 24,44,46 ]。
Wound closure — For most patients with uninfected bite wounds, we suggest that the wounds be left open to heal by secondary intention rather than by primary closure (algorithm 1 and figure 2). (See "Minor wound evaluation and preparation for closure", section on 'Type of closure'.)
Primary closure is a reasonable alternative in a patient with a facial laceration (including a cat bite) that is sufficiently large to affect cosmesis or a gaping dog bite on the trunk, arm, or leg (not on a hand or foot) who meets all of the following criteria:
●Uninfected wound
●Immunocompetent patient
●Recent bite (<12 hours old for bites on an extremity, <24 hours old for facial bites)
●No crush injury or puncture wound
●No prior episode of cellulitis or venous/lymphatic compromise on the affected extremity
For a wound that may benefit from primary closure but has one of these contraindications, the patient may be started on prophylactic antibiotics with a plan for delayed primary closure after three to four days. Unless the clinician has extensive experience with delayed primary closure, referral to a surgeon or other wound expert is advised since additional debridement (eg, of excessive accumulated granulation tissue) may be necessary at the time of closure. (See "Minor wound evaluation and preparation for closure", section on 'Delayed primary closure'.)
The choice of bite wound closure (ie, primary closure, healing by secondary intention, or delayed primary closure) should be individualized to the nature of the wound, whether irrigation and debridement can reasonably clean the wound, and the immune status of the host. Primary closure hastens healing and reduces adverse cosmetic outcomes [1,22,44,52-55]. However, for small wounds and puncture wounds, the potentially increased risk of infection from primary closure typically outweighs the minimal cosmetic benefit [24]. Facial wounds are an exception given increased cosmetic consequences and a lower rate of infection compared with other anatomic sites [1,44,49-51]. The waiting period during delayed primary closure permits the host defense system to decrease bacterial load and to ensure that no infection develops, which is a contraindication to closure.
We agree with the Infectious Diseases Society of American (IDSA) guidelines for most cases (eg, against primary closure of nonfacial cat bites) [1]. However, even though the IDSA recommends against primary closure of nonfacial dog bites, we agree with other experts who favor primary closure of lacerations due to dog bites on the trunk, arms, or legs (though not on the hands or feet) [46,47]. Studies have found that primary wound closure does not increase the risk of infection in such bites but is associated with improved cosmetic outcomes [44,46,47]. However, primary closure of hand wounds, puncture wounds, or wounds with delayed presentations (eg, >8 hours since injury) is associated with an increased rate of infection [24,44,46].
