FBC and U+Es be carried out in patients with severe wounds or who are systemically unwell
X-rays or ultrasound examination should be carried out if the bite is on the hand or could have damaged bones or joints, or if a foreign body could be lodged in the wound or in the bone
hospital admission and referral
due to the high risk of penetrating injury and bone, joint or tendon damage or infection, people with bites must be referred to a plastic or orthopaedic surgeon for surgical exploration, washout and debridement if they have crush wounds; puncture wounds over or near a joint or tendons; bites on the hand or forearm; bites with significant necrosis; or where a foreign body may be present
hospital admission may be indicated if a patient has fever; sepsis; spreading cellulitis; significant oedema or crush injury; loss of function in an affected limb; or they are immunocompromised or unlikely to adhere to therapy
patients exposed to simian herpes virus should be hospitalised and isolated with strict barrier precautions
wound closure:
bite wounds carry a high risk of infection owing to inoculation of oral bacteria
not all wounds should be closed
wound closure considerations (2)
small wounds
may be left open to heal by secondary intention with daily non-stick dressing changes until the skin has re-epithelialised
gaping wounds
can be approximated and closed after copious irrigation and debridement
wounds to the face from any animal
can be closed (for cosmesis; the face has no higher risk of infection than elsewhere)
feline bite
should avoid closing all non-facial wounds
canine bites
majority can be closed except in the hands or feet, where infection risk is much higher
human bites
should avoid closing non-facial wounds or facial wounds more than 24 hours after injury
requires follow up with a plastic surgeon
puncture wounds
have an especially high risk of infection
should let all puncture wounds heal by secondary intention (after irrigation)
tetanus prevention - see linked item
Reference:
Drug and Therapeutics Bulletin (2004);42:65-72.
Colmers-Gray I N, Tulloch J S, Dostaler G, Bai A D. Management of mammalian bites BMJ 2023; 380 :e071921 doi:10.1136/bmj-2022-071921
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