Note
- All bite wounds and deep scratch wounds have a high risk of infection (approximately 85%).
- Inpatient admission is required for all bite injuries of the hand with bone and joint involvement. The consilium hand surgery is recommended in this case.
- Verification of tetanus protection!If no or insufficient vaccination protection or in case of doubt: simultaneous vaccination, active and passive (5-12 hours after injury).
- Rabies prophylaxis is rarely required. If necessary, consultation with the official veterinarian for risk evaluation.
Surgical procedure
- In any case, a bite wound requires medical attention.
- The wound is thoroughly cleaned and disinfected due to the very high risk of infection. The wound is not closed!
- Note
- Urgently discourage wound irrigation with button cannulas or infusion catheters!
- Small bite wounds – especially bite injuries of the hand – are often underestimated in their importance. Here, generous indication for surgical debridement under anesthesia in the operating room.
- Injured with a bite wound head and neck (especially common in children): care in a plastic surgery facility and consular involvement of an otolaryngologist (lesions of the cheek may continue into the oral cavity). Most facial lesions can be sutured primarily.
- Injured persons with a bite wound to the hand should be presented immediately to a hand surgery center; facial bite injuries to a plastic surgery facility.
- Injured persons with a bite wound in the extremities: there are no uniform recommendations on this; wound infections do not occur more frequently with sutured bite wounds than with secondary healing
- Injured persons with wounds extending to a bone or joint must be hospitalized.
- Wound treatment or surgical care should comply with the following procedure:
- In the case of a vascular injury, the focus is on stopping the bleeding. For this purpose, it is usually sufficient to apply pressure to the wound.
- Inspection (viewing) to detect deeper injuries of muscles, vessels, nerves, bones.
- Wound cleaning (preferably with disposable gloves) – remove foreign bodies, then rinse the wound with plenty of fluid (NaCl 0.9%). A saline solution is suitable, but tap water is also sufficient.
- Disinfection – Here, special disinfectants (eg, 1% organoiodine solution) should be used.
- If there are deeper injuries, they must be treated first, otherwise debridement (wound toilet, ie removal of dead (necrotic) tissue)/in the case of wound edge bruising, a wound edge excision is necessary.
- Cave (Caution): bite wounds of the hand must not be closed by suturing.
- Wound site in functional position immobilize and as far as possible thereby hold in an elevated position.
- Daily wound check and dressing change (until a dry wound is present).
