Bites

Background

Are severe of human bite injuries
Commonly present as a small wound over the MCPJ of the dominant hand (patient striking another person's teeth)
Human bite wounds to the hand more commonly develop bacterial infection than human bites at other sites, with clenched fist injuries conferring the highest risk, particularly because of the potential for breaching the MCP joint space to produce septic arthritis or osteomyelitis
Clinical 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 and the clenched positions

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.