Response to chicco et al. communication entitled 'Management and outcomes of mammalian bite injuries during COVID-19 and implications for future practice' Published: November 07, 2020DOI:https://doi.org/10.1016/j.bjps.2020.10.090

The Covid-19 pandemic has forced us to treat mammalian bite injuries more conservatively as resources were redirected to the Covid effort resulting in limited availability of hospital beds and theatre space. When comparing our outcomes before and during the first Covid-19 lockdown, this more conservative approach, which resulted in 24% less admissions and 19% less washouts in theatre, did not result in an increased infection rate. An increased rate of bite injuries during the national lockdown period was also noted. We support the conclusion by Chicco et al. that the majority of patients with bite injuries can ‘safely be managed with washout under local anaesthesia, oral antibiotics and discharge on the same day with safety net advice’. It is interesting that in some aspects of our care we may find Covid-19 has been beneficial in de-medicalising management of certain injuries and conditions.

A multicentre, randomized, double-blind trial of the safety and efficacy of mannose-6-phosphate in patients having Zone II flexor tendon repairs

The safety, tolerability and preliminary efficacy of mannose 6-phosphate in enhancing the outcome in Zone II flexor tendon repair was studied in a multicentre parallel double-blinded randomized controlled trial. Eight UK teaching hospitals were involved in treating repaired flexor tendons with a single intraoperative intrathecal dose of 600 mM mannose 6-phosphate, with follow-up over 26 weeks. A total of 39 patients (mannose 6-phosphate, n = 20; standard care, n = 19) were randomized. Seven were excluded from the safety and tolerability analysis because of intraoperative findings and eight were excluded due to early dropout (n = 4) or tendon rupture (n = 4), leaving 24 (mannose 6-phosphate, n = 13; standard care, n = 11) for assessment of total active motion. The safety, tolerability and other side effects were comparable between the groups. There was no significant difference between the two groups in the total active motion at Week 26. We concluded that mannose 6-phosphate, although safe and tolerable, had no beneficial effect on finger range of motion after Zone II tendon division.Level of evidence 1b.