Background
- Bite injuries account for 1% of ED visits
- Dog bites commonest (80-90% of presentations)
- Cats bites more frequently infected than dogs
- Human bite wounds = 3% of bite presentations
- Beware reptile or "wild" animal (e.g. seal) bites - consult micro. with all
Clenched fist injuries
- Are severe of human bite injuries
- "Small" wound over the MCPJ of the dominant hand (patient striking another person's teeth)
- Infection risk: Clenched fist>Hand>other sites
- Examination should focus on the possibility of extensor tendon injury and joint penetration
- Extensor tendon retracts when the hand is opened, so evaluation needs to be done with the hand in both the open and clenched positions
Management
- Intact skin surrounding dirty wounds can be scrubbed with a sponge and 1% iodine solution or soap and water
- Copious irrigation (warmed solution 33-37° [Evidence])of the wound with normal saline using a 19-G syringe is necessary
- Wounds that are dirty and contain devitalized tissue should be cleaned and debrided
- Fresh head & neck wounds can generally be primarily closed
- Bite wounds to the hand or feet should be left open for delayed primary closure or secondary intention. Non-puncture wounds elsewhere may be safely treated by primary closure after thorough cleaning. [BestBets].
- Patients with significant hand wounds should be referred early to the soft tissue clinic (referral form) to evaluate the need for exploration
- Complete management of bite injuries should include consideration of tetanus immunisation
- For potential hepatitis exposure cases, please see needlestick page
Wounds of low risk (face, scalp, ears or mouth, large, clean lacerations) should be re-evaluated (GP or ANP) in 2 days time.