[Management of bite injuries].

Abstract

Bite injuries cause contaminated wounds with a high risk of infection. It is a progressive process. The prognosis depends less on the extent of the surface area but more on the depth of penetration. Due to the close spatial relationships the structures in the hand are particularly at risk from bite injuries. This study evaluated the dynamics of the disease progression based on the extent of injury and the timing of treatment initiation. A total of 332 bite injuries were treated and retrospectively analyzed. The severity of injuries was classified into five grades based on the affected compartments. The evaluation of the treatment was conducted according to the timing in four groups. The infection rates increased with the severity of the injury and the elapsed time. On the day of the accident 11% of patients showed signs of infection, rising to 72% the following day under conservative treatment, and 93% if no treatment was initiated by then. Patients treated conservatively elsewhere also showed similar levels. The average number of interventions also increased with the interval between the bite and the start of treatment. Not all bites are equal. The extent matters. Cutaneous injuries show signs of infection in 23% of cases but can mostly be treated conservatively. All deeper injuries require surgical treatment with debridement, immobilization and antibiotics. After immediate surgical treatment revision was necessary in 4% of cases.