A study of primary closure of human bite injuries to the face

PURPOSE

This study evaluated the management of human bite injuries to the face during the period from May 1995 to April 1996.

PATIENTS AND METHODS

Data on 30 patients presenting with human bite injuries during this period were collected on specially designed forms. The information was pooled and analyzed. A standardized surgical treatment consisting of thorough debridement of the wound followed by primary closure either by direct suturing, a local flap, or skin grafting on the day of presentation was used. Most of the cases were treated under local anesthesia. Patients were prescribed tetanus prophylaxis and a course of antibiotics for 1 week. Suture removal was done 1 week postoperatively except for the skin grafts, which were uncovered at 10 days postoperation.

RESULTS

There were 21 males and 9 females ranging in age between 17 and 55 years, with a mean age of 31.8 years. Sixty-six percent of the bites involved the lips. The duration of injury before presentation ranged from 1 to 4 days. In 27 of the cases (90%), wound healing was complete at the time of suture removal.

CONCLUSION

The results indicate that immediate closure of human bite injuries is safe, even with old injuries.

Bite wounds. Early treatment and prophylaxis against infectious complications

Patient education is important for decreasing the incidence and morbidity of animal bites. When bites do occur, immediate treatment should be given according to established recommended guidelines. Copious irrigation may be the most important aspect of wound care. In addition, early initiation of antimicrobial therapy, particularly in patients at high risk for infection, can decrease morbidity and mortality. A patient's tetanus status and risk of rabies must also be identified and appropriate immunoprophylaxis administered.

Osteomyelitis of the skull vault from a human bite

We report a case of extensive osteomyelitis of the skull vault from a human bite. The presentation and surgical management of this unusual condition is described. The microbiological findings are comparable to known patterns of infection after human bites. Surgical management and prophylaxis after this injury are discussed.

Management of bite wounds and infection in primary care

This article describes how to recognize the signs of septic arthritis and flexor tenosynovitis after dog bites, how to identify the need for prompt surgical treatment of septic arthritis to prevent joint destruction, how to determine which wounds should and should not be sutured, and how to choose effective antibiotic treatment.

New York City police officers incidence of transcutaneous exposures

Urban based police officers may be at high risk for the transmission of infectious disease. This study was undertaken to assess the incidence of needlestick and human bites to police officers based in an urban environment. A retrospective analysis of self-reported transcutaneous exposures and demographic information of police officers in the New York City Police Department (NYCPD) for 1992-93 was performed. Urine toxicology results of arrested individuals for 1990-91 was also analyzed. The transcutaneous exposure rate of NYCPD was 38.7 per 10,000. No differences occurred between males and females although officers between 20-29 years old had the highest incidence. The highest exposure rate occurred between 4-10 years of service. Greater than 60% of arrested individuals tested positive for potentially injectable drugs. Urban based police officers continue to have transcutaneous exposure incidents during their career. Widespread vaccination and continued education on universal precautions should be considered for all officers.

Dog, cat, and human bites: a review

It is estimated that half of all Americans will be bitten by an animal or another human being during their lifetimes. The vast majority of the estimated 2 million annual mammalian bite wounds are minor, and the victims never seek medical attention. Nonetheless, bite wounds account for approximately 1% of all emergency department visits and more than $30 million in annual health care costs. Infection is the most common bite-associated complication; the relative risk is determined by the species of the inflicting animal, bite location, host factors, and local wound care. Most infections caused by mammalian bites are polymicrobial, with mixed aerobic and anaerobic species. The clinical presentation and appropriate treatment of infected bite wounds vary according to the causative organisms. Human bite wounds have long had a bad reputation for severe infection and frequent complication. However, recent data demonstrate that human bites occurring anywhere other than the hand present no more of a risk for infection than any other type of mammalian bite. The increased incidence of serious infections and complications associated with human bites to the hand warrants their consideration and management in three different categories: occlusional/simple, clenched fist injuries, and occlusional bites to the hand. This article reviews dogs, cat, and human bite wounds, risk factors for complications, evaluation components, bacteriology, antimicrobial susceptibility patterns, and recommended treatments. Epidemiology, clinical presentation, and treatment of infections caused by Pasteurella multocida, Capnocytophaga canimorsus, Eikenella corrodens, and rhabdovirus (rabies only) receive particular emphasis.

Human bites to the hand

Human bites to the hand or penetrating injuries contaminated with saliva can be a source of aggressive infection and debilitating injury. These types of injuries may also be a mode for the transmission of disease, notably hepatitis B. Dental personnel have an increased risk of experiencing bite injuries and should understand the general principles of appropriate management. Staphylococcal or streptococcal species are often associated with infected bite injuries, and amoxicillin and clavulanate are currently advised for prophylaxis. Wound cleansing and careful monitoring, combined with appropriate prophylaxis, are the mainstays of treatment.

Comparative in vitro activities of azithromycin, Bay y 3118, levofloxacin, sparfloxacin, and 11 other oral antimicrobial agents against 194 aerobic and anaerobic bite wound isolates

The activities of sparfloxacin, levofloxacin, Bay y 3118, azithromycin, cefprozil, loracarbef, and nine other oral antimicrobial agents against 194 aerobic and anaerobic clinical bite wound isolates were determined by the agar dilution method. Sparfloxacin, levofloxacin, and Bay y 3118 were active against all aerobic isolates (MICs at which 90% of the isolates are inhibited [MIC90], < or = 1.0 microgram/ml for sparfloxacin and levofloxacin and 0.1 microgram/ml for Bay y 3118) and many anaerobic isolates, with the exception of the fusobacteria. Azithromycin was more active than erythromycin by 1 to 2 dilutions against many aerobes, including Pasteurella multocida and Eikenella corrodens, and by 2 to 4 dilutions against anaerobic isolates. Cefprozil was more active (MIC90, < or = 1 microgram/ml) than loracarbef (MIC90, < or = 4 micrograms/ml) against aerobic gram-positive isolates, but both had poor activity (MIC90, > or = 16 micrograms/ml) against peptostreptococci. Both cefprozil and loracarbef had MIC90s of < or = 0.5 micrograms/ml against P. multocida.

Tetanus caused by human bite of the finger

A case of generalized tetanus after human bite of the finger is reported. The patient recovered with institutional care. We propose that secondary invasion by Clostridium tetani is the cause for infection. It could be prevented by immediate tetanus prophylaxis, thorough debridement, and primary repair of the wound.

Seroprevalence of hepatitis B and C in a Merseyside hospital for the mentally handicapped

This study reports the prevalence of antibodies to hepatitis B virus (HBV) and C virus (HCV), and the frequency of potential exposure to these viruses among patients and staff in six long-stay wards of a hospital caring for mentally handicapped adults from the Mersey region. A retrospective survey of risk behaviour among 134 patients and questionnaire survey of 75 nursing staff was performed. Serum samples from both groups were tested for HBV markers and patient sera for antibodies to HCV by enzyme-linked immunosorbent assay (ELISA). None of the 102 patients tested had antibodies against HCV, although 17 had detectable antibody to HBV core (anti-HBc). Seven out of the 17 were positive for HBV surface antigen. None was positive for IgM antibody to HBV core. Only 1 out of 61 staff had anti-HBc and none was positive for surface antigen. Twenty-nine of 75 (39%) staff reported bites sufficient to break the skin and 52 (69%) significant other injuries from patients; 25 (31%) of staff had not received HBV vaccination. None of the patients had received HBV vaccine. We conclude that HCV does not appear to be a major hazard in this closed community but the prevalence of HBV markers indicating past exposure among patients is high, vaccine uptake is incomplete and incidents which may allow viral transmission are frequent.

Osteomyelitis of the hand after a human bite

Twenty-four cases of osteomyelitis of the hand after human bite were reviewed. The mechanism of injury was equally divided between incisor bites and clenched fists. Eleven of twelve of the clenched-fist injuries showed a tooth mark in the bone or cartilage at the site of inoculation. The incisor bites showed initial infection of the soft tissues or joint with a secondary infection of the bone. Factors leading to the development of osteomyelitis included a delay of more than 24 hours before debridement or inadequate initial treatment. Bacteriologic study commonly showed mixed infections with skin and oral flora. The infections were prone to relapse, and nine patients required more than one surgical debridement.

Skyline view of the metacarpal head in the assessment of human fight-bite injuries

With the fingers extended, the severity of the bony injury from human fight-bite injuries can be underestimated or missed. We describe a "skyline view" of the metacarpal head highlight the intra-articular damage that can occur.

Tetanus following human bite

We present an unusual case of tetanus which followed a human bite. The patient, a 43-year-old woman, developed tetanus within 4 days of sustaining a human bite. She died 6 days after admission despite aggressive management in the intensive care unit.

Primary closure of human bite losses of the lip

Human bite injuries of the lip have, because of the potentially contaminated nature of the wounds, been managed by delayed repair after an interval of about 3 months or more when the infection was controlled and the wound healed. On the contrary, from 1985 to 1990, at a plastic surgery unit in Nigeria, a developing country, 37 patients with human bite losses of the lip were managed by an aggressive approach utilizing (1) a 5-day course of antibiotics locally known to be effective against bacterial flora and (2) immediate surgical operation employing the diamond wedge excision method under local anesthesia with direct wound closure. The results have been so favorable that this method of management of human bite injuries is considered a treatment advance.

Human bites in children

Human bites are common during childhood and usually result from fights or aggressive play with another child. Bites may present as indentation marks, scratches, abrasions, contusions, or lacerations. Most human bite wounds are sustained on the upper extremities, followed by the face and neck, the trunk, and the lower extremities. Infection is the most common complication. Cultures of an infected bite wound yield an average of five microorganisms. This article reviews the current recommendations on the management of human bite wounds in children.