Compartment syndrome in victims of dog bites

Negative pressure wound therapy for serious dog bites of extremities: a prospective randomized trial

OBJECTIVES

The objectives were to investigate the emergency treatment of serious dog bite lacerations on limbs and to identify whether negative pressure wound therapy (NPWT) was beneficial in these instances.

METHODS

A total of 580 cases with serious limb lacerations due to dog bites were randomly divided into 2 groups. After thorough debridement, the limb lacerations of group A (n = 329) were left open. The remaining cases (n = 251) were randomly divided into 2 subgroups, group B and group C, which were treated with 125 and 75 mm Hg of continuous negative pressure, respectively. Antibiotics were only used in cases where there were systemic signs of wound infection, and were not given prophylactically. The infection rate, infection time, and healing time were analyzed.

RESULTS

The wound infection rates of groups A, B, and C were 9.1%, 4.1%, and 3.9%, respectively. The infection times of the 3 groups were 26.3 ± 11.6, 159.8 ± 13.4, and 166.4 ± 16.2 hours, respectively. The recovery times of the infection patients in the 3 groups were 19.2 ± 4.6, 13.2 ± 2.1, and 12.7 ± 2.3 days, respectively, and in the noninfection patients, the recovery times were 15.6 ± 2.7, 10.1 ± 2.3, and 10.5 ± 1.9 days, respectively. In groups B (-125 mm Hg) and C (-75 mm Hg), the infection rate, infection time, and healing time showed no significant differences.

CONCLUSION

Patients with serious dog bite laceration on limbs could benefit from NPWT. Compared with the traditional treatment of leaving the wounds open, NPWT reduced the infection rate and shortened recovery time. When NPWT was performed, low negative pressure (-75 mm Hg) had the same positive effects as high pressure (-125 mm Hg). Prophylactic antibiotics administration is not recommended for treating this kind of laceration.

LEVEL OF EVIDENCE

Therapeutic/care management, level II.

Imaging of sports-related muscle injuries

Muscle derangements in athletes have a wide variety of causes, treatments, and prognoses. Given that the cause and severity of sports-related injuries may be difficult to determine clinically in some cases, MR imaging is utilized increasingly to evaluate muscle injuries in athletes. After reviewing useful MR imaging techniques, this article focuses on MR imaging of the most common causes of muscle pain and disability in athletes, including myotendinous strain, delayed onset muscle soreness, muscle contusion, myositis ossificans, muscle laceration, muscle herniation, and compartment syndrome. The differential diagnosis of various signal intensity abnormalities in muscle also is reviewed.

Dog Bites: Bacteriology, Management, and Prevention

Dog bites are among the most frequent causes of non- fatal injuries in the United States. Most dog bites involve children and young adults. Infected wounds are polymicrobial in nature; the most prevalent organisms are Pasteurella, streptococci, staphylococci, and Fusobacterium, Bacteroides, and Porphyromonas species. Musculoskeletal and neurovascular injuries, as well as systemic infections, can be complications of dog-bite wounds. Treatment includes thorough cleansing of the wound, with copious irrigation. Abscesses, when present, should undergo incision and drainage. Suitable antibiotics for the initial empiric and expectant therapy include amoxicillin-potassium clavulanate, a penicillin with a first generation cephalosporin, or clindamycin and a fluoroquinolone (eg, for patients allergic to penicillins). Preventive strategies should be aimed at public awareness of basic animal safety and responsible pet ownership.