Bite Injuries to the Hand - Review of the Literature

Abstract

Patients presenting to the emergency department with bite injuries to the hand sustain them through a number of causes including domesticated as well as stray animal bites, and human bites commonly sustained as a result of violence. The nature of the injuries sustained can be very deceptive. A small tooth mark on the exterior can be a fulminant infection in the tissues deeper down. Tendon injuries, fractures of the metacarpals and phalanges and management of the wound are critical issues faced by a surgeon in dealing with such patients. Similarly the less common bite injuries to the hand, often with disastrous and sometimes fatal complications, do also present to the emergency department. A high incidence of suspicion is needed in dealing with these injuries effectively. In our article we discuss the common as well as uncommon causes of bite injuries to the hand and their management. In addition to reviewing the literature to ascertain the management of such injuries, we also discuss interesting and rare case reports.

Early complications of human bites to the hand in HIV-positive patients

“…Delay in presentation has been documented extensively in the literature as the single most important determinant of morbidity following human bites to the hand. 3,6,7,12,15,16 In our series, the association between time to presentation and the development of complications did not reach statistical significance (p=0.07). There was however an increased risk of surgical amputation in cases with a delay in presentation (p=0.05).…”

“…18 Immune compromise has been mentioned as a risk factor for the development of infection following human bites to the hand. 7,[12][13][14][15]19 Our data suggests that an HIV-positive patient is not necessarily at increased risk for the development of early complications, irrespective of anti-retroviral therapy or the patient's CD4 count. HIV-positive status was however associated with an increased duration of hospital stay (p < 0.01).…”

Molecular characterization of Pasteurella multocida isolates from swine lungs by Randomly Amplified Polymorphic DNA

“…The occurrence of P. multocida in other species has also been reported, such as pasteurellosis ('snuffles') in rabbits, fowl cholera in poultry, hemorrhagic septicemia in ruminants and animal scratches and bites in humans (ARUMUGAM et al, 2011;ASHRAF et al, 2011;LÓPEZ et al, 2013;WILSON & HO, 2013RAVAL et al, 2014 (KICH et al, 2007). P. multocida is a Gram-negative bacterium grouped into five capsular serogroups (A, B, D, E and F) and is further classified into 16 somatic serotypes according to the lipopolysaccharide antigen (HEDDLESTON, 1972;PIJOAN, 2006;BOROWSKY et al, 2007).…”

Bite wounds and antibiotic prescription among patients presenting to an Australian emergency department

“…Therapeutic Guidelines Australia provides peer-reviewed guidelines to assist clinicians in prescribing (eTG Complete, 2015). Oral amoxicillin with clavulanic acid 875/ 125 mg 12-hourly is considered to be the most appropriate firstline therapy in high-risk wounds as a defence against beta-lactamaseproducing anaerobic bacteria (Raval et al, 2014). In patients with a penicillin allergy, oral ciprofloxacin 500 mg 12-hourly plus oral clindamycin 450 mg 8-hourly is indicated.…”