Human bite injuries to the head and neck: current trends and management protocols in England and Wales

Abstract

Human bites pose a number of unique problems, ranging from cellulitis to the transmission of communicable diseases. The maxillofacial surgeon has the added dilemmas surrounding subsequent repair and reconstruction. Appreciation of the complexity of human bite injuries will ensure optimal care for the patient. We propose a set of guidelines developed 'in-house' to assist in the management of human bite injuries.

Human bite facial wounds in Bouaké (Côte d'Ivoire): development of a therapeutic algorithm in underdeveloped countries

“…For caregivers, the health status of the abuser is of little interest during immediate care. On the other hand, a serological examination of the victim in the weeks or months following the injury would be useful since the seroconversion of hepatitis B, hepatitis C, and HIV has been established several times after being infected through a human bite [10,11]. This procedure should be part of a standard protocol for the treatment of human bites.…”

“…This is not necessarily the case in underdeveloped countries [4]. Some authors have mentioned contraindications to primary wound closure as follows: infection, treatment time exceeding 24 h, punctiform, avulsion, or suturable wounds under tension, and demonstrated comorbidity or immunocompromised condition [11]. The notion of initial wound necrosis is not included among these contraindications or among the standard classification parameters for human bites [8].…”

Surgical Antimicrobial Prophylaxis in Pediatric Patients Undergoing Plastic Surgery: A RAND/UCLA Appropriateness Method Consensus Study

“…In children, ampicillin-sulbactam is the drug of choice for the initial intravenous dose, whereas amoxicillin-clavulanate is the recommended oral drug [73]. Some authors suggest combining metronidazole with oral amoxicillin-clavulanate therapy [74,75], while others in severe cases recommend adding vancomycin to ampicillin-sulbactam [72].…”

“…Zangari et al, in a review about the clinical records for 127 pediatric patients affected by dog-related injuries, and Jenkins at al., in a randomized controlled trial, suggest associating metronidazole with oral therapy with amoxicillin-clavulanate [74,75]. Bula-Rudas et al, in an extensive pediatric review, recommend adding vancomycin to ampicillin-sulbactam [72].…”

“…The authors therefore considered that the optimal duration could be 5 days [73]. In various reviews, the authors have provided an indication to continue prophylaxis for 3-5 days [51,74] or for 5-7 days [14]. The Infectious Disease Society of America provides 5 days of antibiotic prophylactic therapy as required duration [73].…”