1
|
Serafetinidis E, Campos-Juanatey F, Hallscheidt P, Mahmud H, Mayer E, Schouten N, Sharma DM, Waterloos M, Zimmermann K, Kitrey ND. Summary Paper of the Updated 2023 European Association of Urology Guidelines on Urological Trauma. Eur Urol Focus 2023:S2405-4569(23)00196-7. [PMID: 37968186 DOI: 10.1016/j.euf.2023.08.011] [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: 06/14/2023] [Revised: 08/10/2023] [Accepted: 08/31/2023] [Indexed: 11/17/2023]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Panel for Urological Trauma has produced guidelines in order to assist medical professionals in the management of urological trauma in adults for the past 20 yr. It must be emphasised that clinical guidelines present the best evidence available to the experts, but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients regarding other parameters such as experience and available facilities. Guidelines are not mandates and do not purport to be a legal standard of care. OBJECTIVE To present a summary of the 2023 version of the EAU guidelines on the management of urological trauma. EVIDENCE ACQUISITION A systematic literature search was conducted from 1966 to 2022, and articles with the highest certainty evidence were selected. It is important to note that due to its nature, genitourinary trauma literature still relies heavily on expert opinion and retrospective series. EVIDENCE SYNTHESIS Databases searched included Medline, EMBASE, and the Cochrane Libraries, covering a time frame between May 1, 2021 and April 29, 2022. A total of 1236 unique records were identified, retrieved, and screened for relevance. CONCLUSIONS The guidelines provide an evidence-based approach for the management of urological trauma. PATIENT SUMMARY Trauma is a serious public health problem with significant social and economic costs. Urological trauma is common; traffic accidents, falls, intrapersonal violence, and iatrogenic injuries are the main causes. Developments in technology, continuous training of medical professionals, and improved care of polytrauma patients reduce morbidity and maximise the opportunity for quick recovery.
Collapse
Affiliation(s)
| | | | | | - Husny Mahmud
- Department of Urology, Sheba Medical Centre, Tel-Hashomer, Israel
| | - Erik Mayer
- Department of Surgery & Cancer, Imperial College London, London, UK; Department of Urology, The Royal Marsden Hospital, London, UK
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Marjan Waterloos
- Division of Urology, Gent University Hospital, Gent, Belgium; Division of Urology, AZ Maria Middelares, Gent, Belgium
| | - Kristin Zimmermann
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Noam D Kitrey
- Department of Urology, Sheba Medical Centre, Tel-Hashomer, Israel.
| |
Collapse
|
2
|
Dhillon J, Hoopes J, Epp T. Scoping decades of dog evidence: a scoping review of dog bite-related sequelae. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:364-375. [PMID: 30378009 PMCID: PMC6964408 DOI: 10.17269/s41997-018-0145-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/05/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES There has been considerable literature published focusing on various sequelae to dog bites over the last three decades. Much of the literature has focused on rabies, particularly canine rabies variant, which accounts for the majority of rabies deaths worldwide. This paper describes the complications, the pathogens, and other sequelae resulting from dog bites documented in the literature. METHODS This paper used evidence found through a scoping review which charted the published peer-reviewed and non-peer-reviewed gray literature and online information relating to dog bite incidents. Each complication or sequela was additionally assessed from the viewpoint of Canadian Indigenous, rural, and geographically remote communities, which experience a high number of dog bite incidents annually. SYNTHESIS Peer-reviewed literature (N = 693; case report, original research, and review articles) provided detailed information on specific pathogens, infections, and diseases of interest, especially rabies. However, in addition to these, the sequelae from dog bites may include moderate to severe injuries that further result in anxiety around dogs or post-traumatic stress disorder (PTSD). CONCLUSIONS While a lot of focus in the literature is on rabies as a sequela to dog bites, the impacts of anxiety and PTSD are not as well articulated. Treatment of dog bite injuries may be standardized; however, improved collaborations between diverse health professionals (physicians, veterinarians, counseling services, animal behaviourists, and others) could be of considerable benefit in decreasing the effects of dog bites.
Collapse
Affiliation(s)
- Jasmine Dhillon
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada
- Animal Health Science Directorate, Canadian Food Inspection Agency, 1400 Merivale Rd, Ottawa, ON, K1A 0Y9, Canada
| | | | - Tasha Epp
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada.
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Arluke A, Cleary D, Patronek G, Bradley J. Defaming Rover: Error-Based Latent Rhetoric in the Medical Literature on Dog Bites. J APPL ANIM WELF SCI 2017; 21:211-223. [PMID: 29068711 DOI: 10.1080/10888705.2017.1387550] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article examines the accuracy and rhetoric of reports by human health care professionals concerning dog bite injuries published in the peer-reviewed medical literature, with respect to nonclinical issues, such as dog behavior. A qualitative content analysis examined 156 publications between 1966 and 2015 identified by terms such as "dog bite" or "dangerous dogs." The analysis revealed misinformation about human-canine interactions, the significance of breed and breed characteristics, and the frequency of dog bite-related injuries. Misinformation included clear-cut factual errors, misinterpretations, omissions, emotionally loaded language, and exaggerations based on misunderstood or inaccurate statistics or reliance on the interpretation by third parties of other authors' meaning. These errors clustered within one or more rhetorical devices including generalization, catastrophization, demonization, and negative differentiation. By constructing the issue as a social problem, these distortions and errors, and the rhetorical devices supporting them, mischaracterize dogs and overstate the actual risk of dog bites.
Collapse
Affiliation(s)
- Arnold Arluke
- a Department of Sociology , Northeastern University , Boston, Massachusetts
| | - Donald Cleary
- b National Canine Research Council, Animal Farm Foundation, Inc ., Bangall, New York
| | - Gary Patronek
- c Center for Animals and Public Policy , Cummings School of Veterinary Medicine, Tufts University , North Grafton , Massachusetts
| | - Janis Bradley
- b National Canine Research Council, Animal Farm Foundation, Inc ., Bangall, New York
| |
Collapse
|
5
|
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]
|
6
|
Kang H. Animal bite injuries and vaccination. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.3.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
7
|
Malahias M, Jordan D, Hughes O, Khan WS, Hindocha S. Bite injuries to the hand: microbiology, virology and management. Open Orthop J 2014; 8:157-61. [PMID: 25067969 PMCID: PMC4110396 DOI: 10.2174/1874325001408010157] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 04/05/2014] [Accepted: 04/10/2014] [Indexed: 11/22/2022] Open
Abstract
Bites to the human hand, be it from a pet, a stray animal or even a fellow human, may often have dire consequences for the person suffering the insult. Bites by mammals are a common problem and they account for up to 1% of all visits to hospital emergency rooms, in the UK. Clenched fist injuries to the mouth ('fight bite') are notorious for being the worst human bites. Bite injuries of the hand and their related infections must be monitored vigilantly and managed proactively, by experts in this field of surgery. In this review article we discuss the associated microbiology and virology of these injuries as well as their management.
Collapse
Affiliation(s)
- M. Malahias
- Plastic Surgery Department, Good Hope Hospital, West Midlands, B75 7RR, UK
| | - D. Jordan
- Plastic Surgery Department, Whiston Hospital, Liverpool, L35 5DR, UK
| | - O. Hughes
- Plastic Surgery Department, Whiston Hospital, Liverpool, L35 5DR, UK
| | - Wasim S. Khan
- University College London Institute of Orthopaedics & Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, UK
| | - S. Hindocha
- Plastic Surgery Department, Whiston Hospital, Liverpool, L35 5DR, UK
| |
Collapse
|
8
|
Acar MA, Karalezli N, Güleç A. An Unusual Klebsiella Septic Bursitis Mimicking a Soft Tissue Tumor. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2013. [DOI: 10.29333/ejgm/82368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
9
|
Thomas N, Brook I. Animal bite-associated infections: microbiology and treatment. Expert Rev Anti Infect Ther 2011; 9:215-26. [PMID: 21342069 DOI: 10.1586/eri.10.162] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Human and animal bites may lead to serious infection. The organisms involved tend to originate from the oral cavity of the offending biter, as well as the environment where the injury occurred. A variety of aerobic as well as anaerobic organisms have been isolated from bite wounds, with infection ranging from localized cellulitis to systemic dissemination, leading to severe disease ranging from abscess to bone and joint infection, to endocarditis and brain abscess. Immediate wound management, including recognition of the most commonly associated infectious pathogens, and judicious use of empiric antibiotics are crucial in providing the best care after a bite. Here, we discuss the common animal bite associated infections, and provide the most up to date information regarding their management.
Collapse
Affiliation(s)
- Nicole Thomas
- USAF, Fellow Pediatric Infectious Diseases, National Capitol Consortium 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | | |
Collapse
|
10
|
Abstract
Trauma is the leading cause of death between the ages of 1 and 44 years in the USA. While stabilization of life-threatening injuries is the primary goal in the evaluation of all trauma patients, subsequent diagnosis and treatment of secondary injuries are requirements for good trauma care. The genitourinary system is involved in 10% of trauma cases, and these injuries can be associated with considerable morbidity and mortality. Accordingly, physicians involved in the initial evaluation and subsequent management of trauma patients should be aware of the diagnosis and treatment of injuries that can occur in the genitourinary system. In 2009, the European Association of Urology provided specific recommendations for the evaluation, diagnosis and management of genitourinary trauma. Here, we review and discuss these recommendations in order to provide a concise summary for clinicians involved in the evaluation and management of trauma patients and their associated genitourinary injuries.
Collapse
Affiliation(s)
- Richard A Santucci
- Michigan State College of Osteopathic Medicine, 4160 John R. Street, Detroit, MI 48201, USA
| | | |
Collapse
|
11
|
Chandna P, Adlakha VK, Prabhakar M, Julka S. Orofacial Cat Bite: A Case Report. Int J Clin Pediatr Dent 2009; 2:56-9. [PMID: 25206113 PMCID: PMC4086566 DOI: 10.5005/jp-journals-10005-1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 02/15/2009] [Indexed: 11/23/2022] Open
Affiliation(s)
- Preetika Chandna
- Lecturer, Department of Pedodontics and Preventive Dentistry, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Vivek Kumar Adlakha
- Lecturer, Department of Pedodontics and Preventive Dentistry, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Manisha Prabhakar
- Professor and Head, Department of Pedodontics and Preventive Dentistry, IDST Dental College, Kadrabad, Modinagar
Uttar Pradesh, India
| | - Sanjeev Julka
- Department of Pedodontics and Preventive Dentistry, Jodhpur National University, Jodhpur, Rajasthan, India
| |
Collapse
|
12
|
Akhtar N, Smith MJ, McKirdy S, Page RE. Surgical delay in the management of dog bite injuries in children, does it increase the risk of infection? J Plast Reconstr Aesthet Surg 2006; 59:80-5. [PMID: 16482793 DOI: 10.1016/j.bjps.2005.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Dog bites are contaminated wounds and convention dictates that any surgical treatment should be performed at the earliest opportunity. This practice, however, may be in direct conflict with NCEPOD guidelines to reduce night time operating. We audited our treatment of dog bite injuries in children over a 5-year period (1998-2002) to determine whether delaying surgery to conform to operating guidelines increased the incidence of infection. A retrospective case note study identified 118 patients admitted to Sheffield Children's Hospital with dog bite injuries. Details of their injury, treatment and outcome were recorded. There were 70 males and 48 females and an average age of 6.6 years (range 1-15 years). The most common type of injury was a single laceration (32%) and the most frequent site of injury was the face (59%). The majority of wounds (68%) were cleaned and dressed before theatre and 89% were closed directly after minimal debridement. All patients received prophylactic antibiotics. Of the 114 patients that required surgery, 57 (50%) were operated on within 12 h of their injury and 57 (50%) after 12 h. There were three cases of infection in the early group (<12 h) and none in the delayed group (>12 h). We suggest that delaying the surgical treatment of dog bites in children to avoid operating at night does not increase the infection rate.
Collapse
Affiliation(s)
- N Akhtar
- Department of Plastic and Reconstructive Surgery, Northern General Hospital, Sheffield, UK.
| | | | | | | |
Collapse
|
13
|
Turina M, Cheadle WG. Clinical Challenges and Unmet Needs in the Management of Complicated Skin and Skin Structure, and Soft Tissue Infections. Surg Infect (Larchmt) 2005. [DOI: 10.1089/sur.2005.6.2s-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
14
|
Turina M, Cheadle WG. Clinical Challenges and Unmet Needs in the Management of Complicated Skin and Skin Structure, and Soft Tissue Infections. Surg Infect (Larchmt) 2005. [DOI: 10.1089/sur.2005.6.s2-23] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthias Turina
- From the Veterans Affairs Medical Center, Louisville, and the Department of Surgery, University of Louisville School of Medicine, Louisville, KY, 40292
| | - William G. Cheadle
- From the Veterans Affairs Medical Center, Louisville, and the Department of Surgery, University of Louisville School of Medicine, Louisville, KY, 40292
| |
Collapse
|
15
|
Stierman KL, Lloyd KM, De Luca-Pytell DM, Phillips LG, Calhoun KH. Treatment and Outcome of Human Bites in the Head and Neck. Otolaryngol Head Neck Surg 2003; 128:795-801. [PMID: 12825029 DOI: 10.1016/s0194-59980300254-7] [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: 10/14/2022]
Abstract
OBJECTIVE: Our goal was to review head and neck human bite injuries for demographic, treatment, and outcome data to identify factors influencing infection.
STUDY DESIGN: Retrospective chart review of all human bite injuries (adult and pediatric) over 10 years.
SETTING: Tertiary referral medical center.
RESULTS: We reviewed 40 human bites (average follow-up, 139 days). Young males were the most common victims, altercation was the most common etiology, and auricular avulsion was the most common injury. Six wounds closed primarily became infected (40%) versus no wound infection with delayed closure. Primary wound closure ( P < .01), exposed cartilage ( P < .07), and less than 48 hours of intravenous antibiotics ( P < .06) were associated with postoperative infection ( P < .01).
CONCLUSION: Human bites to the head and neck, especially those with exposed cartilage, are best treated with at least 48 hours of intravenous antibiotics and delayed surgical closure (>24 hours postinjury) to prevent infection.
SIGNIFICANCE: This information enables the clinician who sees these bite wounds infrequently to understand the treatment associated with avoiding infection.
Collapse
|
16
|
Affiliation(s)
- Marcia G Bower
- Abington Memorial Hospital, School of Nursing, Willow Grove, PA, USA
| |
Collapse
|
17
|
Abstract
Clenched fist injuries to the mouth ("fight bite") are notorious for being the worst human bites. These are often treated as minor injuries, without the recognition that the joint capsule, the extensor tendon, or the deep fascial spaces may have been violated and contaminated with oral bacteria. Significant morbidity can result from late presentation or inadequate initial management. The emergency physician needs to remain vigilant for complications associated with closed fist injury. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency physician in the treatment of fight bite.
Collapse
Affiliation(s)
- Andrew D Perron
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | | | | |
Collapse
|
18
|
Abstract
Many bite wound patients seek treatment in primary care clinics instead of emergency departments. Without treatment, bite wounds can become infected. Presenting symptoms are usually wound site pain with cellulitis and purulent drainage. The infection originates from the oropharyngeal flora of the biting animal or human and the victim's skin. Primary care clinicians must be able to assess and manage animal and human bites, initiate antibiotic therapy if indicated, and refer patients for surgery or rabies prophylaxis when appropriate. Prompt assessment and treatment can prevent most bite wound complications.
Collapse
Affiliation(s)
- M G Bower
- Abington Memorial Hospital School of Nursing, Willow Grove, Pa., USA
| |
Collapse
|
19
|
Rodriguez AJ, Barbella R, Castañeda L. Anaerobic dog bite wound infection. Ann N Y Acad Sci 2001; 916:665-7. [PMID: 11193696 DOI: 10.1111/j.1749-6632.2000.tb05357.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A J Rodriguez
- Vargas Medical School, Central University Venezuela, Caracas, Venezuela
| | | | | |
Collapse
|
20
|
MacFarlane C, van Loggerenberg CJ. Human and animal bites and venomous stings. TRAUMA-ENGLAND 2001. [DOI: 10.1177/146040860100300103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Human and animal bites and venomous stings demand careful handling. Immediate resuscitation may be necessary. Severe tissue damage from larger animals frequently requires urgent haemorrhage control, followed by debridement. Subsequent reconstruction is commonly necessary. Smaller bites, and particularly human bites, may easily be underestimated, and can have significant infective sequellae, with particular attention being paid to the potential finger joint injury. Surgical exploration is frequently indicated, debridement, irrigation and antimicrobial therapy being required. Viral transmission, as well as bacterial infection, can result from bites. With regard to envenomation, often a great deal of time and effort is directed at identifying the offending animal and focusing on a specific toxin. It is important to ensure effective general resuscitation first. Thereafter, specific antivenom and antianaphylaxis measures may be taken. A description of the three common envenomation symptom complexes -cyto-complex, neuro-complex and haemo-complex - is presented, along with some causative sources. Principles of resuscitation, wound care and general treatment measures are indicated, and then appropriate specific treatments are recommended. Bites and envenomations vary in different parts of the world and it is important that emergency departments develop appropriate protocols relevant to their locations. Common poisonous animal sources should be identified and symptom complexes anticipated. Specific antivenom therapy, appropriate to the area, should be available. However, the general principles of resuscitation and wound care have pride of place.
Collapse
Affiliation(s)
- C MacFarlane
- Gauteng Department of Health, Emergency Medical Services, Trauma Unit, Johannesburg Hospital and University of the Witwatersrand, Johannesburg, South Africa,
| | - CJ van Loggerenberg
- Medical Rescue International, Emergency Medical Services, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
21
|
Abstract
PURPOSE Animal bites to the external genitalia are rare. We retrospectively evaluated our experience with treating genital trauma caused by animal attacks. MATERIALS AND METHODS We studied the medical records of 10 patients treated in the surgical emergency department at our hospital who presented with genital injury caused by an animal bite from 1983 to 1999. Special attention was given to the severity of injury, surgical treatment, antibiotic prophylaxis and outcome. RESULTS Of the 2 men and 8 boys 8 were attacked by dogs, 1 by a horse and 1 by a donkey, respectively. In all cases initial local treatment involved débridement and copious wound irrigation with saline and povidone-iodine solution. Five patients who presented with minimal or no skin loss underwent primary skin closure, including 2 in whom urethral lacerations were surgically repaired. There was moderate to extensive tissue loss in 5 patients, including degloving penile injury in 2, traumatic spermatic cord amputation in 1, complete penile and scrotal avulsion in a 5-month-old infant, and partial penectomy in 1. Reconstructive procedures provided satisfactory cosmetic and functional results in 8 cases. Antibiotic prophylaxis was administered in all patients and no infectious complications developed. CONCLUSIONS Animal bite is a rare but potentially severe cause of genital trauma and children are the most common victims. Morbidity is directly associated with the severity of the initial wound. Because patients tend to seek medical care promptly, infectious complications are unusual. Management involves irrigation, débridement, antibiotic prophylaxis, and tetanus and rabies immunization as appropriate as well as primary wound closure or surgical reconstruction. Good functional and cosmetic results are possible in the majority of cases.
Collapse
Affiliation(s)
- C M Gomes
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
BACKGROUND AND OBJECTIVES Human bite injuries, while less frequent than cat or dog bites, usually stem from aggressive behavior, sports, or sexual activity. It has been thought that human bites have a higher rate of infection than animal bites, but this view is likely skewed because of the frequency of closed fist injuries presenting to emergency rooms. Human bites to the genitalia also occur, but are not often reported because of embarrassment. GOAL OF THE STUDY We report a genital ulceration after a human bite to the penis and review appropriate diagnostic and therapeutic maneuvers. STUDY DESIGN This article reports the development of a severe genital ulcer associated with a human bite to the penis secondarily infected, as verified by culture, with an oral flora organism Eikenella corrodens. RESULTS The genital ulceration healed after appropriate antibiotic therapy. CONCLUSIONS Treatment of human bites focuses on obtaining an accurate history and performing a salient physical examination, as well as early irrigation and debridement. Transmission of communicable disease should be considered as a possible consequence. Prophylactic antibiotic treatment and primary closure of wounds continue to be areas of controversy.
Collapse
Affiliation(s)
- T Rosen
- Baylor College of Medicine, Department of Dermatology, Houston, Texas 77030, USA
| | | |
Collapse
|
23
|
Machtens E. Management of animal bite injuries of the face: Experience with 94 patients. J Oral Maxillofac Surg 1998. [DOI: 10.1016/s0278-2391(98)90010-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|