Bite Wound Infections

Evaluating and treating mammalian bites

Mammalian bites, typically from dogs, cats, or humans, are a common presentation in EDs and family practice settings, and patients present with varying degrees of complexity. Injuries can range from local to systemic, including aggressive bacterial infections and permanent limb impairment. Using a systematic approach to initial wound assessment, followed by appropriate diagnostic testing and treatment, is critical to improved long-term patient outcomes.

Development of a clinical path for the emergency care of hand bite injuries without signs of infection

HYPOTHESIS

The care of bite injuries has not currently reached a consensus, including in our department. The goal of this study was to evaluate our current care of bite injuries by an assessment of professional practices (APP), then formulate and validate a flowchart to standardize our practices.

MATERIAL AND METHODS

During a first round of file reviewing, 30 files were randomly selected and then evaluated using a 15 item auditing form (group 1). A flowchart was then designed to standardize the care of hand bite injuries and released in our department. Six months later, 30 new files were randomly selected and evaluated using the same auditing form (group 2).

RESULTS

When comparing the results of the 15 items before and after the release of the flowchart, 7 items reached 100% in group 2. The wounds were described more precisely, signs of severity were systematically researched and the antibiotic treatment was standardized. Two items decreased but did not reach 0%: systematic prescription of bacteriologic swabs and X-rays. Using these results the flowchart was improved.

DISCUSSION AND CONCLUSION

Our results showed an improvement of the care of hand bites for 11 items, including 5 that were statistically significant. This flowchart enabled to standardize our practices and could be used in other emergency departments.

Reconstruction of face and scalp after dog bites in children

ABSTRACT Objective: to evaluate the immediate reconstruction of face and scalp after canine bites in children. Methods: we conducted a prospective series of cases treated at the Emergency Unit of the Asa Norte Regional Hospital, Brasília - DF, from January 1999 to December 2014. At the time of patient admission to the emergency, the primary wound closure of the face and scalp bite was performed, regardless of the time or day of the event. The primary treatment of the bites was by means of direct suture, flaps rotation or grafting, depending on the type of wound and surgeon's decision. Results: the study comprised 146 children, with the zygomatic region and scalp being the main sites of head bites. All patients received surgical treatment within the first 24 hours after admission. There were no infectious complications in the cases studied. Conclusion: the findings suggest that the immediate closure of canine bites on the face and scalp in children is safe, even when carried out several hours after injury.