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Hospital referral, further investigation, wound closure

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • further investigations include:
    • FBC and U+Es be carried out in patients with severe wounds or who are systemically unwell
    • X-rays or ultrasound examination should be carried out if the bite is on the hand or could have damaged bones or joints, or if a foreign body could be lodged in the wound or in the bone

  • hospital admission and referral
    • due to the high risk of penetrating injury and bone, joint or tendon damage or infection, people with bites must be referred to a plastic or orthopaedic surgeon for surgical exploration, washout and debridement if they have crush wounds; puncture wounds over or near a joint or tendons; bites on the hand or forearm; bites with significant necrosis; or where a foreign body may be present
    • hospital admission may be indicated if a patient has fever; sepsis; spreading cellulitis; significant oedema or crush injury; loss of function in an affected limb; or they are immunocompromised or unlikely to adhere to therapy
    • patients exposed to simian herpes virus should be hospitalised and isolated with strict barrier precautions

  • wound closure:
    • bite wounds carry a high risk of infection owing to inoculation of oral bacteria
    • not all wounds should be closed
    • wound closure considerations (2)
      • small wounds
        • may be left open to heal by secondary intention with daily non-stick dressing changes until the skin has re-epithelialised
      • gaping wounds
        • can be approximated and closed after copious irrigation and debridement
      • wounds to the face from any animal
        • can be closed (for cosmesis; the face has no higher risk of infection than elsewhere)
      • feline bite
        • should avoid closing all non-facial wounds
      • canine bites
        • majority can be closed except in the hands or feet, where infection risk is much higher
      • human bites
        • should avoid closing non-facial wounds or facial wounds more than 24 hours after injury
        • requires follow up with a plastic surgeon
      • puncture wounds
        • have an especially high risk of infection
        • should let all puncture wounds heal by secondary intention (after irrigation)
  • tetanus prevention - see linked item

Reference:

  1. Drug and Therapeutics Bulletin (2004);42:65-72.
  2. Colmers-Gray I N, Tulloch J S, Dostaler G, Bai A D. Management of mammalian bites BMJ 2023; 380 :e071921 doi:10.1136/bmj-2022-071921

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