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Vergote D, Mentzel M, Andreas M, Moeller RT, Bauknecht S. [Management of bite injuries]. CHIRURGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00104-024-02173-z. [PMID: 39316180 DOI: 10.1007/s00104-024-02173-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/25/2024]
Abstract
Bite injuries cause contaminated wounds with a high risk of infection. It is a progressive process. The prognosis depends less on the extent of the surface area but more on the depth of penetration. Due to the close spatial relationships the structures in the hand are particularly at risk from bite injuries. This study evaluated the dynamics of the disease progression based on the extent of injury and the timing of treatment initiation. A total of 332 bite injuries were treated and retrospectively analyzed. The severity of injuries was classified into five grades based on the affected compartments. The evaluation of the treatment was conducted according to the timing in four groups. The infection rates increased with the severity of the injury and the elapsed time. On the day of the accident 11% of patients showed signs of infection, rising to 72% the following day under conservative treatment, and 93% if no treatment was initiated by then. Patients treated conservatively elsewhere also showed similar levels. The average number of interventions also increased with the interval between the bite and the start of treatment. Not all bites are equal. The extent matters. Cutaneous injuries show signs of infection in 23% of cases but can mostly be treated conservatively. All deeper injuries require surgical treatment with debridement, immobilization and antibiotics. After immediate surgical treatment revision was necessary in 4% of cases.
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Affiliation(s)
- Daniel Vergote
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - Martin Mentzel
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Myriam Andreas
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Richard-Tobias Moeller
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Simon Bauknecht
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
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2
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Wong ZY, Richards M, Wormald JCR. Surgical site infection and patient-reported outcomes in surgically treated soft tissue facial injury: A meta-analysis. J Plast Reconstr Aesthet Surg 2024; 95:319-330. [PMID: 38945111 DOI: 10.1016/j.bjps.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Soft tissue facial injuries (STFI) constitute a huge portion of craniofacial trauma, but the risk of surgical site infection (SSI) and patient-reported outcomes (PROs) following surgical management of STFI are unknown. METHODS A PRISMA-compliant search was conducted from January 1990 until March 2023, and meta-analysis was performed using R. Pooled effects of the outcomes were estimated using the DerSimonian and Laird random-effects model or generalised linear mixed model, when feasible. RESULT Among the 8897 screened studies, 38 were included. Twelve studies reported PROMs (n = 985), whereas 28 studies reported SSI rates (n = 10,996) following operative treatment for STFI. The pooled SSI rate (n = 28) was 3.30 % (95 % CI 1.89 %-5.71 %). Surgical and non-surgical closure did not differ significantly in SSI rate. PROs focused on scar outcomes, cosmetic outcomes, quality of life and psychological impact. Subgroup analysis showed lower SSI risk in operative repair for general facial trauma compared to primary repair, and in general facial trauma compared to other aetiologies. The pooled patient scar assessment scale, score at 6-12 months post-intervention (5 studies, n = 217) was 16.16 (95 % CI 15.34-16.97). Limited evidence is available on the effect and superiority of surgical treatment in cosmetic outcomes, quality of life and psychological impact. CONCLUSION Our findings emphasise the limited and unreliable evidence available on PROs following operative treatment for STFI. Future studies employing robust methodologies are needed to investigate optimal approaches for managing STFI.
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Affiliation(s)
- Zhen Yu Wong
- Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Justin C R Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Botnar Research Centre, Windmill Road, Oxford OX3 7HE, UK.
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Estel K, Scheuermann-Poley C, Goertz O, Urban J, Landscheidt K, Wenzel W, Willy C. [Trauma surgical relevance of bite injuries by animals and humans]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:531-542. [PMID: 38884780 PMCID: PMC11219443 DOI: 10.1007/s00113-024-01441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/18/2024]
Abstract
Bite injuries require differentiated treatment due to the deeply inoculated polymicrobial pathogen spectrum, possible concomitant injuries and pronounced soft tissue damage. Dog bites are the most common bite injuries but are less complicated to heal than human and cat bites. The location of the bite greatly depends on the age and the size of the bite victim as well as the type of bite perpetrator. In every case detection of the pathogen should be carried out to provide the best possible adapted treatment in the event of an exacerbation. The primary antibiotic treatment should be empirical with amoxicillin + clavulanic acid or ampicillin + sulbactam and, if necessary, adjusted according to the antibiogram. Depending on the findings, surgical treatment includes excision of the bite canal and a customized wound debridement. It is important to check the vaccination status of those involved and if indicated, to carry out postexposure prophylaxis for tetanus and rabies.
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Affiliation(s)
- Katharina Estel
- Klinik für Unfallchirurgie, Orthopädie und Septisch-Rekonstruktive Chirurgie, Bundeswehrkrankenhaus Berlin, 10115, Berlin, Deutschland
| | - Catharina Scheuermann-Poley
- Klinik für Unfallchirurgie, Orthopädie und Septisch-Rekonstruktive Chirurgie, Bundeswehrkrankenhaus Berlin, 10115, Berlin, Deutschland
| | - Ole Goertz
- Klinik für Plastische, Rekonstruktive & Ästhetische Chirurgie, Handchirurgie, Martin Luther Krankenhaus und Evangelische Elisabeth Klinik Berlin, Berlin, Deutschland
| | - Jennifer Urban
- Klinik für Plastische, Rekonstruktive & Ästhetische Chirurgie, Handchirurgie, Martin Luther Krankenhaus und Evangelische Elisabeth Klinik Berlin, Berlin, Deutschland
| | - Kristina Landscheidt
- Klinik für Plastische, Rekonstruktive & Ästhetische Chirurgie, Handchirurgie, Martin Luther Krankenhaus und Evangelische Elisabeth Klinik Berlin, Berlin, Deutschland
| | - Werner Wenzel
- Klinik für Mikrobiologie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland
| | - Christian Willy
- Klinik für Unfallchirurgie, Orthopädie und Septisch-Rekonstruktive Chirurgie, Bundeswehrkrankenhaus Berlin, 10115, Berlin, Deutschland.
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Gonzaga MDC, Borges JRJ, Alves TS, de Sousa DER, de Castro MB, Câmara ACL. Domestic dog attacks on livestock referred to a Veterinary Teaching Hospital. Front Vet Sci 2024; 11:1342258. [PMID: 38450030 PMCID: PMC10914968 DOI: 10.3389/fvets.2024.1342258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 03/08/2024] Open
Abstract
Losses and the economic impact of dog attacks (DAs) on livestock are often overlooked and include factors such as decreased production, expenses for treatment and handling, and death of injured animals. This study evaluated the epidemiological, therapeutic, and pathological findings of DAs on livestock over an 11-year survey using the records of farm animals referred to a Veterinary Teaching Hospital. Livestock attacked by dogs included 31 sheep, 11 horses, 3 cattle, 3 goats, and 2 pigs, totaling 50 animals. Anatomical locations injured by dog bites were identified as head/neck, thoracic/pelvic limbs, abdomen/flank, rump/tail, and multiple affected regions (two or more bite sites). Additionally, the severity of the injuries was classified into four degrees adapted from the classification of dog bite injuries in children. Most livestock presented Grade 1 (26%) and Grade 2 (28%) injuries, while Grade 3 and Grade 4 injuries were observed in 46% of DAs. Furthermore, 35 animals (70%) were discharged, 9 (18%) died, and 6 (12%) were humanely euthanized. DAs may represent a significant cause for referring livestock species to clinical care, severe injuries, and a considerable number of deaths. In this study, we provide information regarding DAs on livestock for the first time in Midwestern Brazil.
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Affiliation(s)
- Mariana da Costa Gonzaga
- Large Animal Veterinary Teaching Hospital, College of Agronomy and Veterinary Medicine, Universidade de Brasília, Brasília, Federal District, Brazil
| | - José Renato Junqueira Borges
- Large Animal Veterinary Teaching Hospital, College of Agronomy and Veterinary Medicine, Universidade de Brasília, Brasília, Federal District, Brazil
| | - Teresa Souza Alves
- Large Animal Veterinary Teaching Hospital, College of Agronomy and Veterinary Medicine, Universidade de Brasília, Brasília, Federal District, Brazil
| | - Davi Emanuel Ribeiro de Sousa
- Veterinary Pathology Laboratory, College of Agronomy and Veterinary Medicine, Universidade de Brasília, Brasília, Federal District, Brazil
| | - Márcio Botelho de Castro
- Veterinary Pathology Laboratory, College of Agronomy and Veterinary Medicine, Universidade de Brasília, Brasília, Federal District, Brazil
| | - Antonio Carlos Lopes Câmara
- Large Animal Veterinary Teaching Hospital, College of Agronomy and Veterinary Medicine, Universidade de Brasília, Brasília, Federal District, Brazil
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Rhodes IJ, Mwangi MW, Romeo DJ, Rhodes WR, Rohde C. Management of Human Bites in a Rural Kenyan Setting: A Plastic Surgeon's 8-Year Experience. Ann Plast Surg 2024; 92:86-91. [PMID: 37962161 DOI: 10.1097/sap.0000000000003730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
INTRODUCTION The treatment of human bites is a common issue facing healthcare practitioners in the developing countries of Sub-Saharan Africa where it has been noted as a growing public health concern. Generally, the desired outcomes from surgical management are healing, function, and aesthetics. We share our 8-year experience at Kapsowar Hospital in Kenya with the presentation, management, and outcome of human bites. We are uniquely situated to do so given the prevalence of human biting in our community and the full-time presence of a plastic surgeon at our institution. To the best of our knowledge, this study is the first to present human bite surgical management by a plastic surgeon certified by the American Board of Surgery working full-time on the African continent. METHODS A retrospective chart review was conducted on all patients who presented to the operating theater at Kapsowar Hospital with a human bite between 2013-2021. After identification of eligible patients, charts were reviewed assessing parameters including age, gender, timing from injury to presentation at hospital, localization of bite, severity of facial wounds using Lackmann's classification, surgical procedure(s), postoperative complications, surgical revisions, antibiotics administered, and circumstance of incident. Data were analyzed using SPSS 29.0.0.0. RESULTS Forty-four patients were identified. Seventeen (38.6%) were female and 27 (61.4%) were male. Thirty-one patients had facial bites and 13 patients had bites to other parts of the body. Of facial bites, 70.3% resulted in amputation of the affected part while 29.7% were lacerations. Using Lackmann's classification for facial bite severity, IIIA bites (complete avulsion) were most common for both males (9) and females (7). Females comprised 68.4% of total lip bite victims. Bites to the extremity were associated with late presentation and infection. We report a salvage rate of 85.7% for infected digits. CONCLUSIONS Compared with most other studies on human bites, our patient population presents with a higher rate of avulsive lip injuries, most commonly among women. Our postoperative infection rate is lower than many others reported in the literature. Satisfactory cosmetic outcome with low risk of infection can be achieved by following well-established principles of wound healing and tension-free closure.
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Affiliation(s)
- Isaiah J Rhodes
- From the Columbia University Vagelos College of Physicians and Surgeons, New York City, NY
| | - Mark W Mwangi
- Plastic and Reconstructive Surgery Department, Kapsowar Hospital, Kapsowar, Kenya
| | - Dominic J Romeo
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - W R Rhodes
- Plastic and Reconstructive Surgery Department, Kapsowar Hospital, Kapsowar, Kenya
| | - Christine Rohde
- From the Columbia University Vagelos College of Physicians and Surgeons, New York City, NY
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Maurer M, Schlipköter C, Gottsauner M, Waiss W, Meier JK, Fiedler M, Schuderer JG, Taxis J, Reichert TE, Ettl T. Animal Bite Injuries to the Face: A Retrospective Evaluation of 111 Cases. J Clin Med 2023; 12:6942. [PMID: 37959407 PMCID: PMC10649818 DOI: 10.3390/jcm12216942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/24/2023] [Accepted: 11/04/2023] [Indexed: 11/15/2023] Open
Abstract
The treatment of bite wounds to the face is discussed controversially in relation to surgery and antibiotics. The aim of this study is a retrospective evaluation of 111 cases of animal bite injuries to the face that presented to our unit of oral and maxillofacial surgery over a 13-year period. Children under 10 years of age were predominantly involved. A total of 94.5% of the assessed injuries were caused by dogs. Wound infections occurred in 8.1%. Lackmann type II was the most common type of injury (36.9%). The perioral area was affected most frequently (40.5%). Primary wound closure was carried out in 74.8% of the cases. In 91.9% of the cases, antibiotic prophylaxis was prescribed. The most often administered type of antibiotic was amoxicillin with clavulanic acid (62.1%). Patients without antibiotics showed an increased infection rate without significance. Wound infections occurred significantly more frequently in wounds to the cheeks (p = 0.003) and when local flap reconstruction was necessary (p = 0.048). Compared to the other surgical treatment options, primary closure showed the lowest infection rates (4.8%, p = 0.029). We recommend antibiotic prophylaxis using amoxicillin with clavulanic acid and wound drains for wounds of Lackmann class II or higher. Primary closure seems to be the treatment of choice whenever possible.
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Affiliation(s)
- Michael Maurer
- Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
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Sandhaus H, Boakye EA, Johnson M. Incidence of facial fractures in association with facial laceration from dog bites in the pediatric patient. Int J Pediatr Otorhinolaryngol 2023; 172:111639. [PMID: 37478789 DOI: 10.1016/j.ijporl.2023.111639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Dog bite injuries occur in approximately 102 of every 100,000 population. Pediatric facial injuries due to dog bites are more common than in the adult largely due to height difference and ease of access for the dog to the head and neck region. Although majority are soft tissue injuries, pediatric facial fractures from dog bites are estimated at approximately 5%, with the true incidence unknown. We hypothesize that depth and facial subsite of laceration can indicate likelihood of facial fracture presence in pediatric patients with dog bite injuries. METHODS This single-institution retrospective study included 162 patients 18 years or younger (n = 162) who had an ICD-9 code of E906.0 or ICD-10 code of W54.0 for dog bites in the head and neck region between 1/1/2015 and 12/31/2019 and were treated in the emergency department by either an emergency department, otolaryngology, or plastics surgery provider. Multivariable logistic regressions were used to examine the association between patient age, sex, and dog size, and the outcomes: laceration depth (epidermis, dermis, muscle, bone), and facial subsite (upper, middle, lower third). RESULTS Males had a lower laceration penetration at the epidermis level (aOR = 0.36; 95% CI 0.19, 0.69) but a higher laceration penetration at the muscle level (aOR = 2.29; 95% CI 1.04, 5.04) compared to females. No significant findings were observed for the levels of dermis and bone. In the multivariable analysis, there were no significant associations to suggest facial fractures found between facial subsites and age, sex and dog size. CONCLUSION No significant associations between depth or facial subsite of facial injury from dog bites and the presence of facial fractures in pediatric patients except with regard to male sex and laceration level of epidermis and muscle.
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Affiliation(s)
- Henya Sandhaus
- Department of Otolaryngology - Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Eric Adjei Boakye
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA; Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health, Detroit, MI, USA
| | - Matthew Johnson
- Department of Otolaryngology - Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
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Sawhney S, Kwaskowski T, Promod P, Mumtaz S. RE: Pediatric Dog Bites to the Face May Have Been Less Severe During COVID 19 Pandemic: A Retrospective Cohort Study. J Oral Maxillofac Surg 2023; 81:660. [PMID: 37270282 DOI: 10.1016/j.joms.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/15/2023] [Accepted: 01/15/2023] [Indexed: 06/05/2023]
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Besmens IS, Politikou O, Greminger M, Calcagni M. [Bite Injuries - Diagnosis and Treatment]. PRAXIS 2023; 112:93-96. [PMID: 36722114 DOI: 10.1024/1661-8157/a003996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Bite Injuries - Diagnosis and Treatment Abstract. In Switzerland 50% of the people get bitten by an animal once in their lifetime. Almost 20% of all bite injuries lead to infections. All bite wounds should be debrided and irrigated with saline. Primary wound management is critical in terms of reducing the risk of infection. Injuries to the hands and face should be treated by a hand or plastic surgeon.
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Affiliation(s)
- Inga S Besmens
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich, Schweiz
| | - Olga Politikou
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich, Schweiz
| | - Martina Greminger
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich, Schweiz
| | - Maurizio Calcagni
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich, Schweiz
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Aydin O, Aydin Goker ET, Arslan ZA, Sert HM, Teksam O. Clinical features and management of animal bites in an emergency department: a single-center experience. Postgrad Med 2023; 135:31-37. [PMID: 36093812 DOI: 10.1080/00325481.2022.2124089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This study aimed to evaluate the clinical features, management, and outcomes of patients with animal bites presented to the pediatric emergency department of a tertiary center. METHODS Patients with ICD-10 code W54 (contact with dog) and W55 (contact with other mammals) between March 1st, 2017, and July 1st, 2021, were included in the study. Demographic characteristics of the patients, type of contacted animal, wound characteristics (muscle involvement, soft tissue defect, vascular injury, type of nerve injury, and Lackmann's classification), wound care measurements, tetanus prophylaxis, administration of rabies immunoglobulin and antibiotics, location of the injury, existing fractures, suturing, splinting, surgical consultations and hospitalization status were recorded. RESULTS Four hundred and nineteen incidents of animal bites (240 males and 179 females) occurred over a four-year period. 51% was due to a dog bite; 47% was by a cat. The median age was nine years (IQR: 5-14 years). Most bites (91.6%) involved only a single anatomical site. The extremities were the commonly involved part (right upper limb [35.3%], left upper limb [21.2%], right lower limb [12.6%], left lower limb [16%]). Head-neck and face injury ratio was 17.6%. Torso (5.7%) and genitalia (5.2%) were uncommonly involved. A consultation was requested from at least one surgical department for 8% of the patients. 97.1% of patients received a rabies vaccine. Most attacks were trivial and did not require hospitalization. CONCLUSION Animal bites often cause minor injuries. However, multiple dog attacks can be seen related to a high number of stray animals in our country. Therefore, these patients may present with major traumas. Surgical intervention and hospitalization may be required. Emergency physicians play an essential role in acute management and rabies prophylaxis in these patients.
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Affiliation(s)
- Orkun Aydin
- Division of Pediatric Emergency, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | | | | | - Ozlem Teksam
- Division of Pediatric Emergency, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Kolbe V, Bingert R, Märzheuser S, Büttner A. [Caution: aggressive! Dog bite injuries in clinical forensic medicine]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:246-255. [PMID: 36282329 PMCID: PMC9950238 DOI: 10.1007/s00104-022-01741-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/05/2022]
Abstract
Younger children in particular are at risk of becoming victims of dog attacks due to their small size. Such a biting incident can fulfil various criminal offences. In order to be able to satisfy possible legal claims, the injuries should be documented by forensic medicine and thus be legally binding. Therefore, close cooperation between the treating surgeons and forensic experts is recommended. A retrospective analysis of the cases of dog bite injuries in children and adults treated by clinical forensic medicine at the University Medical Center Rostock was carried out under various aspects. Adult casualties were predominantly injured on the lower extremities. The children examined were predominantly bitten on the head, neck and face region as well as the upper extremities. Injury severity ranged from skin redness to severe substance defects with loss of body structures. The biting dog was known in about half of the cases. In order to avoid dog bites in children, parents as well as children should be trained in dealing with dogs.
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Affiliation(s)
- V. Kolbe
- grid.413108.f0000 0000 9737 0454Institut für Rechtsmedizin, Universitätsmedizin Rostock, St.-Georg-Str. 108, 18055 Rostock, Deutschland
| | - R. Bingert
- grid.413108.f0000 0000 9737 0454Institut für Rechtsmedizin, Universitätsmedizin Rostock, St.-Georg-Str. 108, 18055 Rostock, Deutschland
| | - S. Märzheuser
- grid.413108.f0000 0000 9737 0454Klinik für Kinderchirurgie der Chirurgischen Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Deutschland
| | - A. Büttner
- grid.413108.f0000 0000 9737 0454Institut für Rechtsmedizin, Universitätsmedizin Rostock, St.-Georg-Str. 108, 18055 Rostock, Deutschland
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Singhal R, Sikka N, Namdev R. Animal bite injuries in pediatric population: a systematic review. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2022. [DOI: 10.1051/mbcb/2022021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives: To assess the scientific literature pertaining the risk factors for injuries among victims of animal bite injuries. Data and sources: A systematic review of scientific literature published until May 2020 was carried out in the following databases: PubMed, Cochrane Library, Google Scholar and Journals@ovid. Study selection: A total of 924 records were found, of which 29 articles fulfilled the inclusion criteria and were analyzed. There was a male preponderance in most of the studies with male/female ratio ranging from 0.75:1 to 2.1:1. The age range varies from 0 to 19 years with the mean age varying from 3.6 to 8 years. Pitbulls, Rottweiler's, German shepherds, Bull terriers, Labradors and Dobermans were breeds with higher risk of attack. The animals were familiar to the victim (own, friends, neighbors) in 27–98% instances. Most cases of animal bite injuries were recorded during Summer and Spring months. Head and neck followed by extremities was found to be most inflicted area. Conclusions: The sociodemographic characteristics of victim as well as the biting animal affect the circumstances leading to biting episode. However, the results should be interpreted with caution due to the high heterogeneity among studies and moderate quality evidence.
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Saha S. Life-Threatening Panfacial Wild Dog Bites in a Child. Wilderness Environ Med 2021; 32:511-516. [PMID: 34446361 DOI: 10.1016/j.wem.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/17/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
Infants and toddlers can sustain grievous craniofacial injuries after dog bites, some of which may be life-threatening. An 18-mo-old male child presented to our emergency department with complex panfacial wounds after being bitten by an unvaccinated wild dog 6 h earlier. Primary management, hemostasis, and rabies postexposure prophylaxis were performed near his home. Initially, he was resuscitated from severe hemorrhagic shock and anemia in a pediatric intensive care unit. After stabilization, early primary repair of all facial injuries was performed. Surgical exploration revealed multiple full-thickness avulsions, lacerations, nasal bone fractures, facial muscle injuries, and right ear necrosis. Gentle tissue-handling and meticulous reconstruction satisfactorily restored his facial soft-tissue contours about 64 h after the bite injury. Postoperatively, recovery was uneventful except for localized soft-tissue infection caused by multidrug-resistant Pseudomonas, which resolved with appropriate antibiotics. Nine months later, his face and ear appeared almost symmetrical with well-settled scars. Psychological recovery progressed smoothly, excepting few incidences of panic attacks that were triggered by loud noises. Here, we observed that early primary reconstruction of severely mauled soft tissues after wild dog bites, performed within 72 h with adequate precautions, safely produced satisfying long-term outcomes.
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Affiliation(s)
- Srinjoy Saha
- Department of Plastic Surgery, Apollo Gleneagles Hospital, Kolkata, India.
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Abstract
Dogs are the animal most frequently implicated in causing bite injuries to the human face. Dog bite injuries are most prevalent in younger patients. Pasteurella species are commensals of the oral microbiome of dogs and cats and are frequently implicated in infections resulting from dog and cat bite injuries. HIV, hepatitis B, and hepatitis C need to be considered in bites inflicted by humans. All animal bite wounds should be washed out. Most animal bite injuries can be managed in an outpatient setting. Given the cosmetically sensitive nature of the face, bite wounds generally merit suturing, even in delayed presentations.
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Affiliation(s)
- James Murphy
- Oral and Maxillofacial Surgery, Cook County Health, 1969 W. Ogden Avenue, Chicago, IL 60612, USA
| | - Mohammed Qaisi
- Oral and Maxillofacial Surgery, Cook County Health, 1969 W. Ogden Avenue, Chicago, IL 60612, USA; Midwestern University, Chicago, IL, USA.
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15
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Schild S, Puntarelli TR, delaPena M, Johnson A, Butts SC. Facial Soft Tissue Injuries in Pediatric Patients. Facial Plast Surg 2021; 37:516-527. [PMID: 33990127 DOI: 10.1055/s-0041-1727246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Soft tissue injuries of the head and neck are a common reason for medical evaluation and treatment in pediatric populations with some unique and important considerations when compared with adults. The incidence and type of injuries continue to evolve with the adoption of new safety measures, technology advancements, and education of the general population. The goal of this article is to provide the reader with a thorough understanding of the evaluation and management of pediatric soft tissue trauma including the initial workup, physical examination, appropriateness of antimicrobial therapy, and setting for surgical repair. Additionally, the pediatric anesthetic considerations for evaluation and repair in regard to local anesthesia, sedation, and general anesthesia are described in detail. There is a focus on dog bites, perinatal injuries, and child abuse as these entities are distinctive to a pediatric population and have particular management recommendations. Lastly, application of the reconstructive ladder as it applies to children is supported with specific case examples and figures. Although there are many parallels to the management of soft tissue injury in adults, we will highlight the special situations that occur in pediatric populations, which are imperative for the facial plastic and reconstructive surgeon to understand.
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Affiliation(s)
- Sam Schild
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, New York.,Department of Otolaryngology, Kings County Hospital Center, Brooklyn, New York
| | | | - Margarita delaPena
- Department of Anesthesiology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Adam Johnson
- Department of Otolaryngology, University of Arkansas Medical School, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Sydney C Butts
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, New York.,Department of Otolaryngology, Kings County Hospital Center, Brooklyn, New York.,Division of Facial Plastic and Reconstructive Surgery; Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, New York
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16
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Sunderkötter C, Becker K, Eckmann C, Graninger W, Kujath P, Schöfer H. Calculated initial parenteral treatment of bacterial infections: Skin and soft tissue infections. GMS INFECTIOUS DISEASES 2020; 8:Doc11. [PMID: 32373436 PMCID: PMC7186924 DOI: 10.3205/id000055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This is the ninth chapter of the guideline "Calculated Parenteral Initial Therapy of Adult Bacterial Disorders - Update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. The chapter contains the first German S2k guidelines for bacterial skin and soft tissue infections. They encompass recommendations on diagnosis and treatment of the defined entities erysipelas (caused by beta-hämolytic streptococci), limited superficial cellulitis (S. aureus), severe cellulitis, abscess, complicated skin and soft tissue infections, infections of feet in diabetic patients ("diabetic foot"), necrotizing soft tissue infection and bite injuries.
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Affiliation(s)
- Cord Sunderkötter
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Karsten Becker
- Institut für Med. Mikrobiologie, Universitätsklinikum Münster, Germany
| | - Christian Eckmann
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Peine, Germany
| | | | - Peter Kujath
- Chirurgische Klinik, Medizinische Universität Lübeck, Germany
| | - Helmut Schöfer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt/Main, Germany
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17
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Sikka N, Jayam C, Choudhary RS, Bala S. Animal Bite in a 6-month-old Child and Facial Injury with Associated Unusual Nasal Injury: Management of Injuries along with 1-year Follow-up. Int J Clin Pediatr Dent 2019; 12:560-565. [PMID: 32440075 PMCID: PMC7229397 DOI: 10.5005/jp-journals-10005-1683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In children, accidental injuries (AI) are the most common cause of major trauma. Although rare, nonaccidental injuries (NAI) can also cause major trauma. Among NAI, animal bites form a significant fraction. Animal bites form a significant fraction of NAI in children. Amongst animal bites, dog and cat bites are the most common. In adults, the likelihood of bites is on leg/thigh but in children due to their low stature, bites are more common on scalp, head, neck, or chest region. As children have lower tissue mass/size, what appears a small wound in adults comparatively appears as a larger wound in children, causing severe disfigurement. The present paper discusses cat bite injury to maxillofacial region, distinguishing from other differential diagnoses. Potential complications, initial management, and total rehabilitation of facial injuries especially nasal injury caused by a cat in a 6-month-old child are also discussed.
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Affiliation(s)
- Neha Sikka
- Department of Dental Materials, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
- Neha Sikka, Department of Dental Materials, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India, Phone: +91 9416330633, e-mail:
| | - Cheranjeevi Jayam
- Department of Dentistry, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Rama S Choudhary
- Department of Dentistry, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Shashi Bala
- Department of Dental Materials, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
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18
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Children Have an Increased Risk of Periorbital Dog Bite Injuries. J Oral Maxillofac Surg 2019; 78:91-100. [PMID: 31568755 DOI: 10.1016/j.joms.2019.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Dog bites to the head, neck, and face (HNF) disproportionately affect children. It is unclear if specific facial regions are uniquely at risk in this population. Both the periorbital region and the central target area (CTA; nose, lips, and cheeks) have been proposed as being at increased risk. This study addressed the following question: Among individuals sustaining a dog bite injury to the HNF, are children, when compared with adults, at greater risk of injury to the periorbital region or CTA? PATIENTS AND METHODS Using a retrospective cohort design, we enrolled a sample composed of patients presenting with HNF dog bite injuries. The predictor variable was age category: pediatric or adult (≥18 years). The primary outcome variable was injury location: isolated periorbital, isolated CTA, both periorbital and CTA, or other HNF location (neither periorbital nor CTA). Other variables included specific facial structures injured, demographic characteristics, injury circumstances, and clinical course. Descriptive and bivariate statistics were calculated. RESULTS The sample consisted of 183 pediatric (58.5%) and 130 adult (41.5%) patients. Isolated periorbital injuries were more common in the pediatric group (relative risk [RR], 2.2 [95% confidence interval (CI), 1.3 to 3.7]; P = .003), as was injury to both periorbital and CTA regions (RR, 2.0 [95% CI, 1.2 to 3.5]; P = .01). Isolated CTA injury was the most common injury pattern overall in both children and adults, but children were at significantly less risk than adults (RR, 0.7 [95% CI, 0.5 to 0.9]; P = .002). Children were also less likely to sustain an injury to other HNF regions (RR, 0.6 [95% CI, 0.3 to 0.97]; P = .038). CONCLUSIONS Children were twice as likely as adults to incur a periorbital dog bite, but no such increased risk was observed for the CTA. This may reflect unique anatomic risks in children or targeting of their eyes by attacking dogs, contributing to higher rates of HNF injury in this population. Public health measures should recommend against children being at eye level with dogs, even if familiar or under adult supervision.
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19
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Essig GF, Sheehan CC, Niermeyer WL, Lopez JJ, Elmaraghy CA. Treatment of Facial Dog Bite Injuries in the Emergency Department Compared to the Operating Room. OTO Open 2019; 3:2473974X19858328. [PMID: 31428728 PMCID: PMC6684144 DOI: 10.1177/2473974x19858328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/26/2019] [Accepted: 05/30/2019] [Indexed: 12/22/2022] Open
Abstract
Objective To assess factors associated with repair of facial dog bites in the emergency department (ED) versus the operating room (OR) and to compare rates of surgical site infection and reoperation for each venue. Study Design Case series with chart review. Setting Single institution. Subjects and Methods All patients younger than 18 years of age who underwent surgical repair by a consulting surgical service within 24 hours of presentation for facial dog bites between 2010 and 2013 were included. Demographics, site of injury, associated evidence of complex injury, surgical site infections within 30 days, and reoperation within 2 years were compared between patients undergoing surgical repair in the ED versus the OR. Results One hundred sixty-five patients were evaluated; 75 patients underwent repair in the ED, and 90 patients were treated in the OR. Patients treated in the ED underwent surgery more promptly than patients treated in the OR (median time from arrival to procedure start 3.3 vs 6.8 hours, P < .001). Patients treated in the OR were more likely to have longer lacerations (3.0 cm vs 7.8 cm, P < .001), lacerations of the eyelid (17% vs 42%, P = .001), involvement of multiple regions of the face (11% vs 22%, P = .039), and multiple indicators of severe injury (3% vs 12%, P = .024). There were no differences in surgical site infections (1% vs 1%, P = .721) or reoperation rates (5% vs 13%, P = .071). Conclusions Surgical management of pediatric facial dog bites may be successfully performed in both the ED and OR settings. Severity of the injury should dictate the choice for management.
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Affiliation(s)
- Garth F Essig
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cameron C Sheehan
- The Ohio State University College of Medicine, Columbus, Ohio, USA.,Baylor College of Medicine, Houston, Texas, USA
| | | | - Joseph J Lopez
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Charles A Elmaraghy
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Pediatric Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
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20
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Ghezta NK, Bhardwaj Y, Ram R, Ahsan R, Arya S. Incidence Pattern of Bear-Inflicted Injuries to the Maxillofacial Region—Soft and Hard Tissue Injuries, Their Management, and Sequelae. J Oral Maxillofac Surg 2019; 77:1043.e1-1043.e15. [DOI: 10.1016/j.joms.2018.12.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/25/2018] [Accepted: 12/25/2018] [Indexed: 11/25/2022]
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21
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Tanquary G, Little A, Morales-Torres JA. Air of the Dog: Impending Respiratory Failure After a Dog Bite. Cureus 2019; 11:e4304. [PMID: 31183284 PMCID: PMC6538109 DOI: 10.7759/cureus.4304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Animal and human bites represent a significant health issue worldwide. However, penetrating neck trauma secondary to animal bites is a rare presentation. We present the case of a 32-year-old female with neck pain and difficulty breathing after suffering a dog bite to the neck. Bedside ultrasound and subsequent computed tomography (CT) showed findings consistent with subcutaneous emphysema. Due to rapidly progressing neck swelling and stridor, she required advanced airway management followed by emergent exploratory surgery. We present a case report on impending respiratory failure after a dog bite and review the management of penetrating neck trauma.
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Affiliation(s)
| | - Andrew Little
- Emergency Medicine, Ohiohealth Doctors Hospital, Columbus, USA
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22
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Erickson BP, Feng PW, Liao SD, Modi YS, Ko AC, Lee WW. Dog bite injuries of the eye and ocular adnexa. Orbit 2019; 38:43-50. [PMID: 29874471 DOI: 10.1080/01676830.2018.1470190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/22/2018] [Indexed: 06/08/2023]
Abstract
Dog bites result in a diverse range of injuries and complications in the periocular region, particularly in school aged children. It is therefore incumbent on the oculoplastic surgeon to be well versed in both acute and long-term management. The intent of this review is to provide a systematic evaluation of the epidemiology, principles of dog bite wound care, and specific considerations related to common patterns of ophthalmic injury. Review of clinical literature from 1976 to 2014. The majority of periocular injuries result from seemingly benign interactions between young children and familiar dogs. Aggressive saline lavage combined with selective debridement of devitalized tissue is essential. High-risk wounds and vulnerable patient groups may benefit from preventive antibiotic coverage as well as appropriate rabies and tetanus prophylaxis. While the nuances of surgical repair are variable given the heterogeneity of presentation, systematic examination and an algorithm-driven approach underlie the optimal management of these complex injuries.
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Affiliation(s)
- Benjamin P Erickson
- a Department of Ophthalmology , Stanford Health Care, Byers Eye Institute at Stanford , Palo Alto , California , United States
| | - Paula W Feng
- b Department of Ophthalmology and Visual Science , Yale School of Medicine , New Haven , Connecticut , United States
| | - Sophie D Liao
- c Department of Ophthalmology , University of Colorado School of Medicine , Aurora , Colorado , United States
| | - Yasha S Modi
- d Department of Ophthalmology , New York University School of Medicine , New York , United States
| | - Audrey C Ko
- e Department of Ophthalmology and Visual Sciences , The University of Iowa Hospitals and Clinics , Iowa City , Iowa , United States
| | - Wendy W Lee
- f Bascom Palmer Eye Institute , University of Miami Miller School of Medicine , Miami , Florida , United States
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23
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Coombs AV, Eyerly-Webb SA, Solomon RJ, Sanchez R, Lee SK, Carrillo EH, Kiffin C, Rosenthal AA, Whitehouse J, Germain B, Davare DL. Investigating Clinical and Cost Burdens of Law Enforcement–Related K9 Injuries: The Impact of “the Bite” on a Community Hospital. Am Surg 2019. [DOI: 10.1177/000313481908500133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The decision to introduce canines (K9s) to a law enforcement (LE) agency does not typically involve the evaluation of the fiscal or clinical impact on local hospitals. This study compared injury, cost, and care associated with K9s to a common nonlethal force method, the Thomas A Swift Electrical Rifle (TASER), to highlight the cost and resources required to treat both patient types. Patients treated for LE-related K9 and TASER injuries at a Level I community-based trauma center (2011–2016) were evaluated for level of care required (e.g., surgeon/specialist), clinical interventions, proxy medical costs, and length of stay (LOS). Nearly one-third of K9 patients required tertiary-level medical care. The cost of treating the K9-inflicted injuries (n = 75) was almost twice as costly as care for patients subdued with a TASER (n = 80); the K9 patients had significantly (one-tailed t tests) higher medical costs (P = 0.036), required more medical procedures (P = 0.014), and had longer LOS (P = 0.0046) than the TASER patients. Patients with K9 injuries had higher acuity and were significantly more expensive to treat with longer LOS than TASER injuries. LE agencies considering establishing and operating a K9 unit should initiate discussions with their local medical first responders and health-care facilities regarding the capabilities to treat severe K9 injuries to ensure adequate resource allocation.
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Affiliation(s)
- Andre V. Coombs
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
- Mount Sinai Medical Center, Miami Beach, Florida
| | | | - Rachele J. Solomon
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Rafael Sanchez
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Seong K. Lee
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Eddy H. Carrillo
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Chauniqua Kiffin
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Andrew A. Rosenthal
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Jill Whitehouse
- Joe DiMaggio Children's Hospital, Pediatric Trauma Services, Hollywood, Florida
| | - Barbara Germain
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Dafney L. Davare
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
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24
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McGuire C, Morzycki A, Simpson A, Williams J, Bezuhly M. Dog Bites in Children: A Descriptive Analysis. Plast Surg (Oakv) 2018; 26:256-262. [PMID: 30450344 DOI: 10.1177/2292550318767924] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To describe characteristics of dog bites and their treatment in a pediatric population including infection, medical specialties involved, rates of admission, and need for surgery. Method Patients presenting with a dog bite to the emergency department of a tertiary care pediatric hospital between January 1, 2015, and June 30, 2017, were included. Details related to demographics, complications, consultations, and treatment were extracted from the patients' records. Descriptive statistics were performed and binary logistic regression was used to assess potential predictors of infection. Results One hundred fifty-eight dog bite patients were identified. Most patients were male (53.8%) and less than 5 years of age (50%). Bites occurred most frequently in June (13.3%) and July (16.5%). The face was most commonly involved (42.9%), followed by the hands (12.6%) and the scalp (26.6%). Pit bulls (11.4%), Labrador retrievers (7.0%), and German shepherds (4.4%) were the most common offending breeds. Most bites were superficial (91.1%). Half were treated conservatively with dressings and petrolatum-based ointment, with 41.1% requiring simple primary closure. Ten (6.3%) cases necessitated primary repair in the main operating room under general anesthesia. More than half of patients were treated with prophylactic systemic antibiotics (55.1%). Plastic surgery was the most common service involved (24.7%). Seven (4.4%) patients developed an infection and there were no mortalities or long-term complications. Rates of infection did not differ between patients who did or did not receive prophylactic systemic antibiotics (P = .88). Regression analysis revealed no significant predictors of infection. Conclusions Most dog bites are superficial and involve the head and hands. Infection rate is low, with no significant difference in infection rates between patients treated with or without prophylactic antibiotics.
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Affiliation(s)
- Connor McGuire
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alex Morzycki
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Simpson
- Division of Plastic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jason Williams
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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25
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Modification of Lackmann's classification of facial bite wounds: an aid to assessment and recording. Br J Oral Maxillofac Surg 2018; 56:900-901. [PMID: 30352695 DOI: 10.1016/j.bjoms.2018.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Indexed: 11/21/2022]
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26
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[Surgical treatment of bites]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2018; 30:321-341. [PMID: 30209521 DOI: 10.1007/s00064-018-0563-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/21/2018] [Accepted: 06/07/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Thorough and profound debridement for acute bite injuries while sparing nerves, vessels and tendons. INDICATIONS Acute traumatic and late presented bite injuries. CONTRAINDICATIONS General contraindication for anesthesia or surgery. SURGICAL TECHNIQUE Extensive flabellate local anesthesia/general anesthesia, wound irrigation using 0.9% NaCl or antiseptic solutions, removal of avital tissues, wound debridement, wound edge excision, anew extensive irrigation, drainage if necessary, wound closure where applicable (except older or punctual deep injuries), bandage, elastic wrapping and immobilization. If necessary, plastic surgery with coverage of remaining defects. POSTOPERATIVE MANAGEMENT Immobilization with initially daily wound evaluation, removal of drainage/loop on postoperative day 2; if necessary, antibiotic therapy with amoxicillin and clavulanic acid in high-risk wounds (e.g., puncture wounds, joint or bone involvement, extensive soft tissue squeezing), suture removal on day 10-12 after surgery. RESULTS Of 142 bite injuries that were treated and retrospectively evaluated, 46% were caused by dogs and 32% by cats. Patients were on average 44 years old; 55% of all dog bites affected women, but 67% of all cat bites. In 48% of the cases, general anesthesia was necessary. The postoperative infection rate was 6.3%.
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27
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Piccart F, Dormaar JT, Coropciuc R, Schoenaers J, Bila M, Politis C. Dog Bite Injuries in the Head and Neck Region: A 20-Year Review. Craniomaxillofac Trauma Reconstr 2018; 12:199-204. [PMID: 31428244 DOI: 10.1055/s-0038-1660441] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/20/2018] [Indexed: 10/28/2022] Open
Abstract
Dog bite-related wounds seem to have become a common problem, especially when they relate to the head and neck region. According to Overall and Love, up to 18 per 1,000 people sustain a dog bite every year, of whom 3 need medical attention. Approximately 1 to 2% of bite injuries require hospitalization of the victims. Most of the lacerations are found in the upper lip and the nose regions and they are classified according to severity and concomitant damage to other organs. Bite wounds are considered "dirty" wounds and are prone to infection. When dealing with bite wounds, there is always an indication for antibiotic treatment. Broad-spectrum antibiotics like amoxicillin-clavulanate and/or moxifloxacin cover most of the pathogenic flora and should be administered in every bite wound case at risk of infection. This article would like to present a medical record review: a retrospective analysis of all bite wounds sustained in the head and neck region, treated at the University Hospital of Leuven over the past 20 years. Furthermore, it provides an overview of the current literature and its standings on the treatment of dog bite injuries in the maxillofacial region. We assessed both surgical and medical treatment options, as well as primary management, which includes infection prevention strategies, closure management, and additional vaccination requirements. Secondary management or scar revision methods will be mentioned. After conducting a UZ Leuven database search using keywords such as "dog," "dog bite," "face," "head," "lip," and others, 223 patients were included. Age at the time of injury, location of the injury, treatment method used, and whether secondary infection was present or not were documented. All patients have been divided in age groups. We concluded that 21.52% was 5 years old or younger. Almost half of our patients (49.33%) were 18 years old or younger. Of all patients, 79 were hospitalized (35.43%). Primary closure was the treatment of choice. In 141 patients, the wounds were closed primarily (63.23%), resulting in only 2.24% reported secondary infections. Only one fatality was reported in our center over the course of 20 years (0.45%), a 6-year-old girl who had been attacked by her father's Rottweilers. Most patients who sustained dog bite injuries in the head and neck region seem to be children, specifically toddlers. Due to their height, it is possible they are more prone to dog bite injuries in the head and neck region. It is essential to optimize management of these injuries due to the impact they have on patients. This article provides the epidemiological data and clinical outcome of the approach at our center.
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Affiliation(s)
- Frederik Piccart
- Department of Oral and Maxillofacial Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Jakob Titiaan Dormaar
- Department of Oral and Maxillofacial Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Ruxandra Coropciuc
- Department of Oral and Maxillofacial Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Joseph Schoenaers
- Department of Oral and Maxillofacial Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Michel Bila
- Department of Oral and Maxillofacial Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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28
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Online videos indicate human and dog behaviour preceding dog bites and the context in which bites occur. Sci Rep 2018; 8:7147. [PMID: 29740161 PMCID: PMC5940802 DOI: 10.1038/s41598-018-25671-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/26/2018] [Indexed: 11/16/2022] Open
Abstract
YouTube videos of dog bites present an unexplored opportunity to observe dog bites directly. We recorded the context of bites, bite severity, victim and dog characteristics for 143 videos and for 56 videos we coded human and dog behaviour before the bite. Perceived bite severity was derived from visual aspects of the bite. Associations between bite severity and victim, dog and context characteristics were analysed using a Bayesian hierarchical regression model. Human and dog behaviour before the bite were summarised with descriptive statistics. No significant differences in bite severity were observed between contexts. Only age of the victim was predictive of bite severity: adults were bitten more severely than infants and infants more severely than children. Non-neutral codes describing dog body posture and some displacement and appeasement behaviours increased approximately 20 seconds before the bite and humans made more tactile contacts with dogs 21 seconds before the bite. This analysis can help to improve understanding of context in which bites occur and improve bite prevention by highlighting observable human and dog behaviours occurring before the bite.
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29
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Heitz C, Louzada GP, Conci RA, Rodrigues RL, Fritscher GG. Primary Repair of a Complex Panfacial Fracture by Dog Bite. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1719. [PMID: 29876169 PMCID: PMC5977943 DOI: 10.1097/gox.0000000000001719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/23/2018] [Indexed: 11/27/2022]
Abstract
Facial fractures due to dog attacks have an unknown incidence rate. To date, only 41 cases of canine bite trauma in a pediatric patient, associated with facial fracture, have been reported in the literature. As major species of involving dogs are the American pitbull terrier and rottweiler. Due to the intense kinematics of this trauma, the treatment becomes complex. Thus, attention to the primary repair of such complex lesions ensures satisfactory results, which is the focus of this discussion. The purpose of this review was to analyze how different ways to approach this type of trauma in children for clarification or correct management. In addition, we address the treatment plan of a complex case of panfacial fracture by a canine bite in a 4-year-old patient. According to a review addressed, the main involved are orbit, nasal, and zygomatic. Antibiotic therapy is indicated for infected bite wounds and wounded considerations at risk of infection, with high complexity and when involving important structures such as bones, vessels, and joints. The state of tetanus immunization and the risk of rabies infection should be routinely addressed in the management of the bite wound.
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Affiliation(s)
- Cláiton Heitz
- From the Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Guilherme Pivatto Louzada
- Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Ricardo Augusto Conci
- Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil
| | | | - Guilherme Genehr Fritscher
- From the Oral and Maxillofacial Surgery, Post-Graduate Program in Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
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Abstract
OBJECTIVE The purpose of this study was to assess the pattern of adult dog bites presenting to a medium size Canadian city’s Emergency Departments. METHODS All adult (≥16 years) patients presenting to Emergency Departments in our region during a 30-month period (January 2013 to June 2015) were identified. Demographics, injury patterns, and dog-specific characteristics were studied. RESULTS A total of 475 dog bites were identified. The greatest proportion of dog bites occurred in the summer months (140, 30%). Pit-bull type was the most frequently implicated breed (27%). The majority of patients identified were female (295, 62%). The majority of bites occurred in the hands (264 cases, 56%). Bites occurring in the head and neck accounted for 11% of all injuries. Although 50% of injuries required only washout and dressing, 15 cases (3%) required a complex primary closure. The operating room was utilized in the reconstruction of eight defects (2%). There were four (1%) tendon repairs, one (0.2%) nerve repair, and one injury requiring a skin graft (0.2%). Three patients were admitted to hospital. We identified an overall infection rate of 10%. CONCLUSIONS Dog bites most commonly occurred in the hands and upper extremities, and carried an infection risk of approximately 10%. Large, muscular breeds were the most frequently implicated. The effectiveness of breed-specific legislation remains unclear, but educational programs for dog owners, children, and health care workers may help decrease the number and severity of attacks.
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Nath T, Imran M, Megu K, Shafath A, Thongdok KW. Management of Maxillofacial Injuries Sustained after a Bear Attack. Ann Maxillofac Surg 2018; 8:369-372. [PMID: 30693268 PMCID: PMC6327797 DOI: 10.4103/ams.ams_169_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
There is a little available literature on injuries sustained due to bear attacks and their management. Bears are agile wild animals and injuries sustained after a bear attack have varying patterns. In general, such cases present to the emergency department with severe maxillofacial injuries with varying patterns, thereby limiting the use of common protocol for the management of such injuries. The aim of this article is to add to the current available literature on bear attacks, a present case of management of maxillofacial injury involving the orbit sustained after a bear attack.
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Affiliation(s)
- Tanmoy Nath
- Department of Oral and Maxillofacial Surgery, Regional Dental College, Guwahati, Assam, India
| | - Mohammed Imran
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Kaling Megu
- Department of General Surgery, Heema Hospital, Itanagar, Arunachal Pradesh, India
| | - Adil Shafath
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
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Comparison of primary and delayed wound closure of dog-bite wounds. Vet Comp Orthop Traumatol 2017; 26:204-7. [DOI: 10.3415/vcot-12-04-0053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 12/28/2012] [Indexed: 11/17/2022]
Abstract
Summary
Background: Primary bite wound suturing in the emergency department remains controversial in some cases.
Objective: We conducted a study to investigate the infection rate and cosmetic appearance between primary wound closure and delayed wound closure in dog bite wounds in humans.
Methods: All patients with bite wounds were treated with oral antibiotic medications. We adopted a randomized cohort study, dividing the patients who needed wound closure into two groups: 60 patients for primary closure, and 60 patients for delayed closure, and compared the infection rate and wound cosmetic appearance scores.
Results: In the primary closure group, four people (6.7%) developed a wound infection without systemic infection. In the delayed closure group, three people (5%) developed a wound infection (p = 0.093), but there were not any patients that developed a systemic infection. Thirty-three patients (55%) in the primary closure group had optimal cosmetic scores, whereas 20 patients (33.3%) in the delayed closure group had optimal cosmetic scores (p = 0.012).
Conclusion: Although primary wound closure for dog bites may be associated with a higher infection rate, the cosmetic appearance after primary closure was still acceptable.
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Begeman L, GeurtsvanKessel C, Finke S, Freuling CM, Koopmans M, Müller T, Ruigrok TJH, Kuiken T. Comparative pathogenesis of rabies in bats and carnivores, and implications for spillover to humans. THE LANCET. INFECTIOUS DISEASES 2017; 18:e147-e159. [PMID: 29100899 DOI: 10.1016/s1473-3099(17)30574-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/23/2017] [Accepted: 09/11/2017] [Indexed: 12/15/2022]
Abstract
Bat-acquired rabies is becoming increasingly common, and its diagnosis could be missed partly because its clinical presentation differs from that of dog-acquired rabies. We reviewed the scientific literature to compare the pathogenesis of rabies in bats and carnivores-including dogs-and related this pathogenesis to differences in the clinical presentation of bat-acquired and dog-acquired rabies in human beings. For bat-acquired rabies, we found that the histological site of exposure is usually limited to the skin, the anatomical site of exposure is more commonly the face, and the virus might be more adapted for entry via the skin than for dog-acquired rabies. These factors could help to explain several differences in clinical presentation between individuals with bat-acquired and those with dog-acquired rabies. A better understanding of these differences should improve the recording of a patient's history, enable drawing up of a more sophisticated list of clinical characteristics, and therefore obtain an earlier diagnosis of rabies after contact with a bat or carnivore that has rabies.
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Affiliation(s)
- Lineke Begeman
- Department of Viroscience, Postgraduate School Molecular Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Corine GeurtsvanKessel
- Department of Viroscience, Postgraduate School Molecular Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Stefan Finke
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Molecular Virology and Cell Biology, WHO Collaborating Centre for Rabies Surveillance and Research, OIE Reference Laboratory for Rabies, Greifswald, Insel Riems, Germany
| | - Conrad M Freuling
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Molecular Virology and Cell Biology, WHO Collaborating Centre for Rabies Surveillance and Research, OIE Reference Laboratory for Rabies, Greifswald, Insel Riems, Germany
| | - Marion Koopmans
- Department of Viroscience, Postgraduate School Molecular Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Thomas Müller
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Molecular Virology and Cell Biology, WHO Collaborating Centre for Rabies Surveillance and Research, OIE Reference Laboratory for Rabies, Greifswald, Insel Riems, Germany
| | - Tom J H Ruigrok
- Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Thijs Kuiken
- Department of Viroscience, Postgraduate School Molecular Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands.
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Saadi R, Oberman BS, Lighthall JG. Dog-Bite-Related Craniofacial Fractures among Pediatric Patients: A Case Series and Review of Literature. Craniomaxillofac Trauma Reconstr 2017; 11:249-255. [PMID: 30574267 DOI: 10.1055/s-0037-1604073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/09/2017] [Indexed: 10/19/2022] Open
Abstract
Dog bites in the pediatric population commonly cause injuries to the head and can be associated with fractures, often leading to prolonged hospital stays, multiple surgical interventions, and long-term complications. Our goal was to evaluate our experience with dog-bite-related craniofacial fractures, understand frequency and demographics of these fractures, identify common fracture patterns, and provide recommendations based on management and complications encountered. The institution's electronic medical record was reviewed. A review of the English literature for the past 20 years was also conducted. A retrospective chart review was conducted using ICD-9 codes to include all patients with head and neck dog bites and craniofacial fractures. Fractures resulting from canine bites to the face and scalp were rare, occurring in our study in less than 1% of total facial dog bites (1,069 cases) and 1.5% of pediatric facial dog bites (462 cases). Ages ranged from 5 months to 9 years at the time of presentation. A total of seven patients, all pediatric, were documented. All seven patients required operative intervention for their wounds, and five patients required at least two operative interventions. Midface and skull fractures were the most commonly encountered fracture sites. Dog bite injuries to the face in young children, especially when severe, should raise suspicion for fracture of underlying bone. Management of these injuries should include a multidisciplinary approach and focus on repair of soft tissue and skeletal deformities. Furthermore, it is prudent to follow up patients who require operative management after injury to monitor for long-term complications, given the significant proportion of complications and operative takebacks in this study.
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Affiliation(s)
- Robert Saadi
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| | | | - Jessyka G Lighthall
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
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Abstract
The management of soft tissue injury after facial trauma poses unique challenges to the plastic surgeon, given the specialized nature of facial tissue and the aesthetic importance of the face. The general principles of trauma management and wound care are applied in all cases. The management of severe injuries to the face is discussed in relation to the location and the mechanism of injury. Facial transplants have arisen in the past decade for the management of catastrophic soft tissue defects, although high morbidity and mortality after these non-life-saving operations must be considered in patient selection.
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Affiliation(s)
- Tara L Braun
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Renata S Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Affiliation(s)
- Christopher J Mannion
- Consultant In Maxillofacial Surgery in the Department of Oral and Maxillofacial Surgery, Leeds Teaching Hospital NHS Trust, Leeds LS1 3EX
| | - Aidan Graham
- Surgical Trainee in Oral and Maxillofacial Surgery in the Department of Oral and Maxillofacial Surgery, Leeds Teaching Hospitals, Leeds
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Agrawal A, Kumar P, Singhal R, Singh V, Bhagol A. Animal Bite Injuries in Children: Review of Literature and Case Series. Int J Clin Pediatr Dent 2017; 10:67-72. [PMID: 28377659 PMCID: PMC5360807 DOI: 10.5005/jp-journals-10005-1410] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 02/22/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction Maxillofacial region in children is particularly vulnerable to animal bite injuries. These injuries may range from insignificant scratches to life-threatening neck and facial injuries. Children are the common victims, particularly of dog bites. Materials and methods Three cases of animal bite injuries in children with their clinical presentation and their management are being presented along with review of literature. Surgical management included cleansing and primary closure of the wound. Rabies and tetanus prophylaxis were given. Discussion The most common site of injury was the face. For the facial injuries, the most frequently affected area was the middle third (55%), also called as the “central target area.” The small stature of children, the disproportionate size of the head relative to the body, their willingness to bring their faces close to the animal, and limited motor skills to provide defense are believed to account for this. The resulting soft-tissue injuries can vary in relation to their extent. Treatment involved initial surgical exploration, and secondary repair later depending on the severity of the injury. Conclusion Prompt assessment and treatment can prevent most bite wound complications. Early management of such injuries usually guarantees satisfactory outcome. Prevention strategies include close supervision of child-dog interactions, better reporting of bites, etc. How to cite this article Agrawal A, Kumar P, Singhal R, Singh V, Bhagol A. Animal Bite Injuries in Children: Review of Literature and Case Series. Int J Clin Pediatr Dent 2017;10(1):67-72.
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Affiliation(s)
- Aviral Agrawal
- Senior Resident, Department of Oral and Maxillofacial Surgery, Kalpana Chawla Government Medical College, Karnal, Haryana, India
| | - Pradeep Kumar
- Dental Surgeon, Department of Oral and Maxillofacial Surgery, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Ruchi Singhal
- Senior Resident, Department of Pedodontics, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Virendra Singh
- Professor and Head, Department of Oral and Maxillofacial Surgery, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Amrish Bhagol
- Assistant Professor,Department of Oral and Maxillofacial Surgery, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
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Sezgin B, Ljohiy M, Akgol Gur ST. Animal-inflicted open wounds in rural Turkey: lessons learned and a proposed treatment algorithm for uncertain scenarios. Int Wound J 2016; 13:1282-1288. [PMID: 26350443 PMCID: PMC7949775 DOI: 10.1111/iwj.12493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/13/2015] [Accepted: 08/07/2015] [Indexed: 11/30/2022] Open
Abstract
Uncertainty in the management of animal-inflicted injuries, especially in rural settings, usually results in a general approach to leave all wounds to heal with secondary intention, which can lead to unsightly scarring and functional loss. This study focusus on different circumstances dealt with by plastic surgeons in a rural setting in Turkey and aims to configure what the general approach should be through an analysis of a wide spectrum of patients. Between June 2013 and December 2014, 205 patients who presented to the emergency department for animal-inflicted injuries were retrospectively analysed. Patients who consulted for plastic surgery were included in the analysis to determine which wounds require further attention. Patients with past animal-inflicted injuries who presented to the outpatient plastic surgery clinic with concerns such as non-healing open wounds or cosmetic or functional impairment were also evaluated. Statistical analysis demostrated a significantly lower rate of infection encountered in animal-inflicted open wounds (AIOWs) of patients who consulted for plastic surgery from the emergency department than those who presented to the outpatient clinic (P < 0·05). The main concern in the management of animal-inflicted wounds is their potential for infection, but this does not mean that every wound will be infected. The most important factor is being able to distinguish wounds that have a higher potential for infection and to select the type of wound management accordingly. An algorithm has been proposed as a guidance for the management of AIOWs, which covers the approach towards both domestic and stray animal-inflicted injuries.
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Affiliation(s)
- Billur Sezgin
- Department of Plastic, Reconstructive and Aesthetic SurgeryKoç University School of MedicineIstanbulTurkey
| | - Mbaraka Ljohiy
- Department of Plastic, Reconstructive and Aesthetic SurgeryErzurum Regional Training and Research HospitalErzurumTurkey
| | - Sultan Tuna Akgol Gur
- Department of Emergency MedicineErzurum Regional Training and Research HospitalErzurumTurkey
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Rothe K, Tsokos M, Handrick W. Animal and Human Bite Wounds. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:433-42; quiz 443. [PMID: 26179017 DOI: 10.3238/arztebl.2015.0433] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 02/09/2015] [Accepted: 02/09/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND 30,000 to 50,000 injuries are caused by bites in Germany every year. Dog and cat bites are common, human bites relatively rare. 25% of the victims are under age 6, and 34% are aged 6 to 17. METHODS This review is based on pertinent literature retrieved by a selective search and on the authors' clinical and scientific experience. RESULTS In small children, most bite wounds are on the head and neck; in older children and adolescents, most are on the limbs. Bite injuries range from trivial ones needing no medical intervention to major soft-tissue defects with the loss of functionally important structures. A bite can transmit unusual pathogens from the saliva into the wound. The risk of infection after a bite is 10-20%, and about 30-60% of the infections are of mixed aerobic-anaerobic origin. Prophylactic antibiotics are recommended only for wounds that are considered at high risk of infection in view of their type and location, the species of the biting animal, and the characteristics of the patient. CONCLUSION Structured surgical management of bite wounds is the most important factor in the prevention of infection. High-risk wounds must be differentiated from trivial ones. Interdisciplinary management is advisable for wounds on the hands and face.
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Affiliation(s)
- Karin Rothe
- Department of Pediatric Surgery, Charité-Universitätsmedizin Berlin, Institute of Forensic Medicine, Charité-Universitätsmedizin Berlin, Medical laboratory, Dr Frank Berthold and colleagues, Frankfurt (Oder)
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Touzet-Roumazeille S, Jayyosi L, Plenier Y, Guyot E, Guillard T, François C. [Surgical management of animal bites in children]. ANN CHIR PLAST ESTH 2016; 61:560-567. [PMID: 27545658 DOI: 10.1016/j.anplas.2016.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 12/15/2022]
Abstract
Children represent a population at risk, because of their short size, their naivety and their attraction to animals. The face and hands are the most specific locations in young children. Wounds are often multiple. In more than half the cases, the child knows the animal, which are dogs and cats by frequency argument. The bite episode occurs mostly when the child is alone with the pet without direct supervision, while playing or stroking the animal. As in all bites, pediatric lesions are infectious, functional and aesthetic emergencies, but the goal of this work was primarily to make a point on principles of surgical management of animal bites in children, highlighting pediatric specificities. Animal bites require psychological, anesthetic and surgical treatment, adapted to the child, in a specialized structure. Hospitalization and general anesthesia are more frequent in children. Any suspicion of mistreatment (and/or abuse) should lead to the child's hospitalization, even if wounds do not justify monitoring in a surgical environment. Emergency surgery is essential to limit functional and aesthetic consequences. The healing capacities of the child and the frequent lack of co-morbidity allow a conservative surgical treatment with suture, repositioning skin flaps and controlled healing in the first place. Immobilization, drainage, and antibiotics will complete the surgery. The healing process, however, leads to a specific management during scar remodeling phase and growth. Psychological care of the child and parents should not be forgotten, and has to start at the same time as surgical treatment at in acute phase.
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Affiliation(s)
- S Touzet-Roumazeille
- Chirurgie maxillo-faciale, hôpital Salengro, CHRU de Lille, rue Emile-Laine, 59037 Lille, France
| | - L Jayyosi
- Chirurgie plastique reconstructrice et esthétique, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - Y Plenier
- Urgences chirurgicales pédiatriques, American Memorial Hospital, CHU de Reims, 47, rue Cognacq-Jay, 51100 Reims, France
| | - E Guyot
- Département d'anesthésie et réanimation, American Memorial Hospital, CHU de Reims, 47, rue Cognacq-Jay, 51100 Reims, France
| | - T Guillard
- Laboratoire de bactériologie-virologie-hygiène, hôpital Robert-Debré, avenue du Général-Koenig, 51100 Reims, France
| | - C François
- Chirurgie plastique reconstructrice et esthétique, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France; Chirurgie pédiatrique, American Memorial Hospital, CHU de Reims, 47, rue Cognacq-Jay, 51100 Reims, France; EA 3801, université de Reims-Champagne-Ardenne, 51, rue Cognacq-Jay, 51100 Reims, France.
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Patronek GJ, Bradley J, Cleary D. Who is minding the bibliography? Daisy chaining, dropped leads, and other bad behavior using examples from the dog bite literature. J Vet Behav 2016. [DOI: 10.1016/j.jveb.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Animal Inflicted Maxillofacial Injuries: Treatment Modalities and Our Experience. J Maxillofac Oral Surg 2016; 16:356-364. [PMID: 28717295 DOI: 10.1007/s12663-016-0918-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 04/27/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Animal inflicted injuries to the face and neck are becoming much more common as people lavish affection on pets. Injuries caused by animal attacks to the face can cause complex injuries to soft and hard tissues, presented as perforations, lacerations, crushes, avulsion or fractures. An uncountable number of bacteria and virus can be found in such injuries, with a potential pathological effect to humans, regarding infections. Although the infection rate is low due to excellent blood supply to face, the injuries have disfiguring effect with possible psychological repercussion to the patients. The treatment of animal inflicted injuries must address the soft tissue defect, neurovascular injuries, and bone injuries as well as prevention of post treatment infection. Primary wound repair is the treatment of choice for most clinically uninfected bite wound where as delayed closure should be reserved for wounds at high risk of infection or already infected wounds and tissue defect may require local flap or micro-vascular re-implantations. MATERIAL AND METHODS In this article, we have elicited up to date considerations regarding the management of animal inflicted injuries to the face based on literature search and exemplified by multiple case reports. CONCLUSION For bite injuries on face, immediate primary wound repair after meticulous wound debridement and irrigation with sufficient volume added by antibiotic prophylaxis gives good cosmetic results with minimum risk of infection. Depending upon type of attack and age of victims, psychiatric or social counseling may also be required.
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Abstract
PURPOSE This study aimed to describe immediate nasal reconstruction using a forehead flap after dog bite injuries. BACKGROUND Dog bites to the nose can avulse multiple aesthetic subunits, making primary repair difficult, inadvisable, or impossible. Microsurgical replantation and composite grafting of the nose have been reported, but this assumes the avulsed nasal segments are salvageable even after the animal's attack. METHODS We present 2 cases of dog bites to the nose with loss of multiple aesthetic subunits. The avulsed portions of the nose were not recovered. A search of the literature (OVID MEDLINE) was also performed, reviewing acute reconstruction of nasal defects after animal bites. RESULTS Acute forehead flaps were used as part of a first-stage operation to reconstruct the nasal defects. Second- and third-stage operations were performed to thin and divide the flap, respectively. Although the defects involved the full thickness of the nose, only the skin and nasal lining were acutely reconstructed. Acute cartilage grafts were not used due to concern of wound contamination; however, some resultant collapse of the nasal vestibule was noted and selectively addressed with subsequent cartilage grafting. DISCUSSION Dog bites to the face can create immediately disfiguring injuries that may initially seem devastating. Nonetheless, soft tissue damage often can be primarily repaired, leading to roughly linear scars that can be revised later. However, nasal injuries from dog bites can be more challenging if multiple subunits are irreparably lost. Acute forehead flap reconstruction after dog bite-concomitant with initial debridement-is a reliable method of reconstruction. It remains to be seen whether acute cartilage grafts would be useful during the first-stage reconstructive operation for better long-term outcomes.
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Management of bite wounds in children and adults-an analysis of over 5000 cases at a level I trauma centre. Wien Klin Wochenschr 2015; 128:367-75. [PMID: 26659907 DOI: 10.1007/s00508-015-0900-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 11/12/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Bite wounds are among the commonest types of trauma to which man is the subject. They account for 5 % of the total traumatic wounds evaluated in the emergency department (ED) and approximately 1 % of all the ED visits. Early estimation of infection risk, adequate antibiotic therapy and if indicated surgical treatment are the cornerstones of successful cure of bite wounds. METHODS A total of 5248 consecutive trauma patients were collected prospectively and analysed retrospectively over a period of 15 years in this study at a level I trauma centre, Department of Trauma Surgery, Medical University of Vienna, Austria. RESULTS The mean age was 33.8 years (range 0-97), 2620 (49.9 %) were male and 2628 (50.1 %) were female individuals. In our study population, a total of 2530 dog bites (48.2 %), 930 cat bites (17.8 %), 357 other animal bites (6.8 %), 426 human bites (8.1 %) and 1005 human self-bites (19.2 %) have been observed. A total of 995 wounds (19.0 %) have been infected. Surgery was done in 132 wounds (2.5 %). CONCLUSION We could show a six times higher infection rate of cat bites compared to dog bites. Human bites showed a total infection rate of 8.2 %. Observed infection rate of puncture wounds and wounds greater than 3 cm was 1.5 times higher than for all other wounds in the present study. Total infection rates within 24 h to antibiotic administration was 29.3 %, compared to 65.0 % < 48 h and 81.1 % < 72 h. Time interval also influenced the overall outcome showing a 2.6 increase in acceptable and 1.3 increase in poor outcome after 72 h.
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Khandelwal P, Hajira N, Dubey S. Management of maxillofacial injuries in humans due to animal bites and mauling: A report of three cases. Niger Postgrad Med J 2015; 22:241-244. [PMID: 26776339 DOI: 10.4103/1117-1936.173981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Animal attacks and bite injuries are common occurrences as the natural habitat of animals is diminishing due to human encroachment. Individuals injured in animal attacks present with different types of injuries. Urgent and effective management of these injuries would have a significant effect on the final outcome. Rabies is a fatal disease in humans, and, till date, only those that received vaccination before the onset of illness survived this disease. The goal of the case reports presented in the article was to document the injuries suffered in animal bite injuries and add to the literature on the management with minimal complications.
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Affiliation(s)
- Pulkit Khandelwal
- From the Consultant Oral and Maxillofacial Surgeon, Metrocity Hospital, Jaipur, Rajasthan, India
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47
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The current concepts in management of animal (dog, cat, snake, scorpion) and human bite wounds. J Trauma Acute Care Surg 2015; 78:641-8. [PMID: 25710440 DOI: 10.1097/ta.0000000000000531] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
UNLABELLED Animal and human bite wounds represent a significant global health issue. In the United States, animal and human bites are a very common health issue, causing significant morbidity and even, in rare scenarios, mortality. Most animal bite wounds in the United States are caused by dogs, with cat bites being a distant second. Human bite wounds constitute a dominant subset of all bite wounds. Several studies of bite wounds have reported improved outcomes with early diagnosis and immediate treatment. However, the available literature on the initial treatment provides a plethora of conflicting opinions and results. In this review, our aim was to identify and assess the current evidence on the management of animal (dog, cat, insects, scorpions, and snakes) and human bite wounds. LEVEL OF EVIDENCE Review article, level III.
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[The assessment of bite injuries from a forensic point of view]. Wien Med Wochenschr 2015; 165:179-84. [PMID: 25502849 DOI: 10.1007/s10354-014-0328-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
The identification of a bite injury and its differentiation between human and animal origin demand a high level of special knowledge from the examining physician. The evaluation of bite injuries in terms of their hazard potential, risk profile and origin is usually done by a forensic specialist based on medical record documentation after immediate medical treatment. Therefore, as a first responder, a detailed documentation of the entire injury pattern is essential. If necessary, samples for further DNA analysis should be taken.The present article is intended to give a brief introduction to various aspects of bite injuries as well as to point out possibilities and limitations of the assessment of such cases.
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Mannion CJ, Graham A, Shepherd K, Greenberg D. Dog bites and maxillofacial surgery: what can we do? Br J Oral Maxillofac Surg 2015; 53:522-5. [PMID: 25912397 DOI: 10.1016/j.bjoms.2015.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 02/25/2015] [Indexed: 10/23/2022]
Abstract
The number of injuries caused by dog bites is increasing in the United Kingdom. We review patients admitted with dog bites to a single maxillofacial department in a district general hospital over a 21-month period. Data include patients' characteristics, and the site and severity of injury. The relationship of the victim to the animal and its breed and classification were added where possible. In total, 65 patients, mean age 22 years (range 1-71, median 14) were included. There were 84 wounds, and their site and severity were recorded according to the Lackmann classification. Twelve different breeds of dog were responsible for the bites. An appreciable proportion of those injured were young children. Educational strategies should aim to reduce the incidence of all dog bites, particularly in young children, as their needs after initial treatment are complex. We propose specific strategies to reduce the number of these injuries.
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Affiliation(s)
- C J Mannion
- Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, West Yorkshire, LS1 3EX, United Kingdom.
| | - A Graham
- Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, West Yorkshire, LS1 3EX, United Kingdom.
| | - K Shepherd
- Veterinary Surgeon and Clinical Animal Behaviourist, 16 Church Street, Finedon, Wellingborough, Northants, NN9 5NA, United Kingdom.
| | - D Greenberg
- Alder Hey Veterinary Hospital, 410 Eaton Road, West Derby, Liverpool, L12 3HG, United Kingdom.
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Touré G, Angoulangouli G, Méningaud JP. Epidemiology and classification of dog bite injuries to the face: A prospective study of 108 patients. J Plast Reconstr Aesthet Surg 2015; 68:654-8. [PMID: 25791430 DOI: 10.1016/j.bjps.2015.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 12/16/2014] [Accepted: 01/05/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dog bites are considered to be septic injuries, and their location on the face, with its highly symbolic topography and important social functions, is particularly pertinent. In addition to specific medical aspects, such as their psychological impact, they are also of relevance in terms of child protection measures. In light of the far-reaching importance of this subject, we were prompted to carry out a prospective study, over 13 years, to identify risk factors. Our results highlight specific risk factors, and they may hence assist with the implementation of concrete primary prevention measures against dog bites. METHODS An information sheet was prepared and filled out during the intake of patients who had been bitten on the face. Data analysis was performed using Epi Info Version 6.04dfr software to find a correlation between the factors studied and the dog bite to the face. RESULTS Dog bites to the face represented 0.83% of the emergency admissions to our service. A considerable majority of these involved children, with 68.5% of patients <16 years of age, and 33.3% of patients aged between 2 and 5 years. The wounds were multiple and of variable severity. The type of dog involved was frequently a German Shepherd. Strikingly, 91.3% of bites had occurred in a single-parent environment. CONCLUSIONS Our study has determined that the fundamental factors that increase the probability of a dog bite to the face are as follows: the child being 2-5 years old, a single-parent context, and involvement of a German Shepherd-type dog.
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Affiliation(s)
- Gaoussou Touré
- Maxillofacial Surgery Department, 40, allée de la source, CHI LR Aubrac, Villeneuve Saint Georges, 94195 cedex Paris, France.
| | - Ghislain Angoulangouli
- Maxillofacial Surgery Department, 40, allée de la source, CHI LR Aubrac, Villeneuve Saint Georges, 94195 cedex Paris, France
| | - Jean-Paul Méningaud
- Henri Mondor-Albert Chenevier Group, Plastic, Reconstructive and Esthetic Surgery Department, Paris 12 University, Faculty of Medicine, Public Hospitals of Paris, 51, Avenue du Maréchal de Lattre de Tassigny Créteil, 94010 Paris, France
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