Mammalian Bite Injuries to the Hand and Their Management

Abstract

Bite wounds are a common form of hand injury with the potential to lead to severe local and systemic sequelae and permanent functional impairment. Mammalian bite wounds may be caused by a variety of animal class and species; injuries resulting from dogs, cats and humans are the most widely discussed and reported in the literature. Bite wounds may be contaminated with aggressive pathogens and the anatomical vulnerability of structures within the hand means that without early recognition and treatment with irrigation and antibiotics, alongside a low index of suspicion for deep structural involvement requiring formal surgical exploration and washout, the consequences of such injuries can be disastrous. We review the literature and discuss the epidemiology, pathophysiology and microbiology relating to these injuries, as well as clinical aspects including signs, symptoms, and management.

A Three-year (2011–2013) Surveillance on Animal Bites and Victims Vaccination in the South of Khorasan-e-Razavi Province, Iran

“…The purpose of surveillance of rabies in Iran is the prevention of animal bite cases that cause fatal disease of rabies since millions of dollars are allocated annually to buy the rabies virus vaccine [7]. Gonabad city has industry livestock and a huge number of domesticated dogs, thus has the most reported animal bites from these dogs as compared to other animals.…”

Evaluation of Knowledge of Emergency Physicians Regarding Assessment and Initial Management of Hand Injuries

“…Jha S et al 51 (2014) found that bite wounds are a common form of hand injury with the potential to lead to severe local and systemic sequelae and permanent functional impairment. Bite wounds can be injuries resulting from the bites of various animals like dogs, cats and even humans and these are the most widely discussed and reported in the literature.…”

“…Jha S et al 51 (2014) found that Bite wounds may be contaminated with aggressive pathogens and the anatomical vulnerability of structures within the hand means that without early recognition and treatment with irrigation and antibiotics, alongside a low index of suspicion for deep structural involvement requiring formal surgical exploration and washout, the consequences of such injuries can be disastrous.…”

Dog bite injuries: can the old dog be taught new tricks?

“…No significant delay had occurred in seeking care, with an ambulance having been called 10-15 minutes post incident. Delay in seeking attention and treatment is shown to significantly increase the likelihood of infection and the need for surgical intervention (Maimaris and Quinton, 1988;Jha et al, 2014). Risk factors which would adversely affect the patient's ability to heal normally, such as chronic disease states including diabetes, liver cirrhosis, renal failure, chronic obstructive pulmonary disease, anaemia, and peripheral vascular disease were excluded.…”

“…This comparatively low infection rate increases with bites to the hand (28% to 47%), where the anatomy, which comprises multiple compartments, and scant presence of soft tissue between skin and bone, lends to potential bacterial infiltration and propagation via structures such as tendons, ligaments and bones (Morgan and Palmer, 2007;Kennedy et al, 2015). It is suggested that 62% of wounds overlying metacarpophalangeal or proximal interphalangeal joints demonstrate penetration of the joint space below (Jha et al, 2014). Complications can include cellulitis, abscess, septic arthritis, osteomyelitis, tenosynovitis, and severe sepsis.…”