Bear Bite with Upper Extremity Amputation and Severe Infection-A Case Report

熊咬造成上臂截肢及嚴重感染－個案報告

周惠能(Wai-Nang Chao) ； 林聿山(Yu-San Lin) ； 黃國峰(Kuo-Feng Huang) ； 楊振(Cheng Yang) ； 林怡嫻(Yi-Shyan Lin)

《中華民國整形外科醫學會雜誌》 18卷1期 (2009/03) Pp. 85-91

https://doi.org/10.7096/JPSA.200903.0085

摘要

背景：
在動物咬傷中最常見的是被貓或狗咬傷。遭熊攻擊導致嚴重傷害及其醫療處置則很少在文獻中提及。
方法：
我們報告一位三歲男童在看完馬戲表演後被關在鐵籠的馬來熊攻擊，造成右上臂被咬斷撕落。斷肢在四小時內重植完成以及積極地用廣效抗生素及術後清創治療。
結果：
由於熊咬的傷口發生嚴重感染以及細菌培養呈多重抗藥性導致無法控制的菌血症，最終不得不把患肢作外科性截除。
結論：
總結我們這次經驗，熊咬傷可能會造成嚴重的機械性傷害及感染。被飼養的熊（如馬戲團或動物園的）其口內的細菌極可能有多重抗藥性。若被這類動物咬傷，除了要使用強而廣效的抗生素治療外，還要積極地對感染的傷口進行清創，細菌培養與調整治療的抗生素。

並列摘要

Background:
Animal bite injuries usually cause by cats or dogs. Bear bite injuries and the following medical treatments are rarely reported in the literatures.
Materials and Methods:
We report a 3-year-old boy who suffered from a circus-bear bite with complete amputation of his right arm. Replantation of the injured limb was performed within 4 hours of warm ischemia. Aggressive broad-spectrum antibiotics treatment and wound debridements were also done post-operatively.
Results:
Surgical amputation had to be undertaken due to the development of sepsis and severe tissue necrosis of the replanted arm.
Conclusion:
Bear bites may cause severe mechanical injuries and infection. Multiple antibiotics resistant bacteria may develop in the oral bacterium of bears bred in zoo or circus. Strong broad-spectrum antibiotics should be administered following such injury. In addition, aggressive debridements, prompt bacterial cultures and modification of antibiotic treatment are necessary.

並列關鍵字

animal bite ； bear bite ； arm replantation ； amputation