Factors related to the resolution of treated hand infections

One hundred thirty-eight patients with acute hand infection (81% deep) treated from 1970 to 1980 in hospital were reviewed. Resolution time of infection was slow, 8 days or longer in 57% of 135 patients and 15 days or longer in 28%. Such slow resolution occurred in infection of closed anatomical spaces and included 50% of all pulp space and joint infections, 23% of tenosynovitis, and 24% of subcutaneous dorsal had infections. There was a direct correlation between increasing treatment delay and slower resolution of infections in pulp spaces, palmar spaces, joints, and tendon sheaths. If the mean treatment delay was greater than a brief 2 1/2 days, 69% of tenosynovitis showed delayed resolution. Other factors associated with the rate of resolution were adequacy of surgical drainage, efficacy of antibiotics, and associated diabetes mellitus.

Primary syphilis following a human bite

The case of a 34-year-old man with primary syphilis is described. The lesions developed on his penis 11 weeks after he sustained a human bite in the same area. Oral administration of cephalexin for five days did not prevent the infection buy may have prolonged the incubation period.

[A case report of macroglossia following tongue bite (author's transl)]

A variety of congenital or acquired diseases may cause macroglossia. We report the case study of a 25 year old patient with Down's Syndrome who developed macroglossia after injury to the tongue from a self-inflicted bite. Conservative therapy for one month through wound revision, antibiotics and antiphlogistics was only successful in controlling infection but failed to prevent the occurrence of a massive macroglossia. This latter problem could only be managed through reconstructive surgery. Histological studies of tissue taken from the tongue revealed the presence of an interstitial edema containing protein, but without evidence for mucopolysaccharides, glycogen or amyloid. A network of dilated blood and lymphatic vessels with partial stenoses caused by organized thrombosis and proliferation of endothelial cells could be observed, suggesting the presence of a congenital lymphangio-hemangioma. However, we believe that these findings were the result of the obliteration of lymphatic and blood vessels through trauma and inflammation to produce the patient's macroglossia.

Biting palsy of the accessory nerve

A young man was bitten by his girl friend at the anterior border of the left trapezius muscle. Weakness of the trapezius resulted and a longstanding ache in the shoulder developed. Clinically and neurophysiologically, an axonotmesis type crush injury of the accessory nerve was verified.

Wounds of the hand contaminated by human or animal saliva

A prospective and retrospective evaluation of 75 patients with hand wounds contaminated by human saliva (35) or animal saliva (40) demonstrates that a program of outpatient management can be sufficient for optimal care in many patients. This series challenges the proposition that hospitalization, radiographs, and surgical debridement are necessary for most such wounds. Sixty-seven per cent did not have surgical intervention and no complications resulted. Ninety-two per cent received antibiotics. Radiographs were obtained only when bony injury or entry into a joint was suspected. Delay in seeking treatment until obvious signs of infection or pain are present is common. Literature review details the anatomic factors important in the natural history and control of these infections, and the changes with respect to modes of treatment for these potentially dangerous wounds. The injury is caused by bites with the hand extended or, in fight-bite wounds, with the metacarpal-phalangeal and interphalangeal joints flexed, allowing deeper penetration and then sealing of the wound when the first is opened. Staphylococcus and Streptococcus are the organisms most frequently found in human bites, and in animal bites; Pasteurella multocida should be considered in dog and cat bites.

Mammalian bite wounds

Clinical data were collected prospectively from a series of 160 patients presenting with mammalian bite wounds. Anaerobic and aerobic cultures were prepared from sterile swabs placed in 65 bite wounds prior to cleansing. Infection was noted in 11 of 22 cat bites, six of 37 human bites, three of 80 dog bites, and in none of the 21 bites caused by other mammals. Pasteurella multocida was recovered from six infected cat and dog bites, all of which developed infection within 24 hours of injury. Staphylococcus aureus and Streptococcus viridans were the principal pathogens isolated from the remaining infected cat, dog, and human bites. Infection most commonly followed puncture wounds caused by cats (10/19) and lacerations into subcutaneous tissue of the hand caused by humans (4/17). None of the 10 sutured wounds became infected. All infected bite wounds responded to antibiotic therapy. No conclusions regarding the value of prophylactic antibiotics could be made.

Two-year review of hand infections at a municipal hospital

Although an unromantic topic, the management of hand infection can tax the patience and skill of the modern day surgeon. The addition of antibiotics to the surgeon's armamentarium have made the job easier than in the days of Kanavel and Koch but has not altered the basic surgical principles of elevation, immobilization and properly planned drainage. Awareness of hand anatomy in relation to infection and awareness of special categories of problems are necessary in preventing crippling deformities in one of our most precious possessions--the hand.

The management of human bite injuries of the hand

Three hundred twenty-seven bite injuries of the hand were reviewed for incidence of infectious complications. A policy to hospitalize all patients with human bite injuries was maintained, but noncompliance was high. Patients with uninfected or superficially infected bites (131) were hospitalized and treated with parenteral penicillin, cephalosporins, or clindamycin (mean duration, 45 hours). Among the 62 patients not lost to followup three minor septic complications occurred. Of similar patients not hospitalized (134), only two thirds received antibiotic therapy but no complications were observed. These data suggest that human bite hand infections can be averted and that established superficial infections can be successfully treated with outpatient antibiotic therapy. Of the 62 patients with moderately to severely infected human bites, 77% were injured by striking an opponent; 52% suffered injury over metacarpophalangeal joints. The mean delay in seeking medical attention was 2 1/2 days, compared to 1/2 day in the less severely infected group. Of the patients with more seriously infected bites, 94% received parenteral antibiotic therapy. Of 30 patients with known outcome in the latter group 27% suffered complications (stiffness; recurrent infection; other infectious complication), confirming the high morbidity of established deep hand infections secondary to human bites.

Bacteriology of human and animal bite wounds

Seventy-three patients with bite wounds (16 patients with clenched-fist injuries, 18 with human bite wounds, and 39 with animal bites) were cultured aerobically and anaerobically. A total of 33 of 34 patients with human bites and clenched-fist injuries and 33 of 39 patients with animal bites had aerobic or facultative bacteria isolated from their wounds. A total of 224 strains of aerobic or facultative bacteria were isolated, the most frequent isolate being alpha-hemolytic streptococci (50 strains). Staphylococcus aureus was isolated from 18 wounds. Penicillin-resistant gram-negative rods were infrequently isolated (12 strains). Anaerobic bacteria were isolated in 18 of 34 human bite wounds and clenched-fist injuries and 16 of 39 animal bite wounds. A total of 88 anaerobic strains was isolated, the most common being various Bacteroides species (36 strains).

Bite-marks on battered children

Instances of human bites are generally rare, although it does sometimes occur that people use their teeth as a means of attack of defence. When looking into cases of the ill-treatment of children we often find bite-marks in addition to other signs of abusement. Eleven cases from the Institute of Forensic Medicine at Düsseldorf University are presented out of a total of 48 cases of ill-treatment of children followed by death in which human bite-marks as well as other haematomas on the victims could be proved. In all cases the cause of death was a subdural haematoma. All but three of the offenders were female, and all were young and subject to excess stress so that the act could eventually be regarded as the result of a disintegration of emotional status. The combination of bite-marks with haematomas and other signs of ill-treatment support with sufficient certainty the conclusion that a criminal action of a third person is involved.

Transmission of hepatitis B by a human bite: an occupational hazard

Hepatitis B developed in a policeman 15 weeks after he was bitten on the hand. A few days after the bite hepatitis B developed in the assailant. The bite had drawn blood and this method of inoculation was presumed to be the route of transmission of the virus. Compensation was awarded on the grounds that this was an occupationally acquired disease.