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Hand Infections
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
Dog bites are the most common animal bite you will encounter, making up around 90% of all animal bites sustained (Figure 3.5) [k]. Like human bites they are prone to infection, with a mix of organisms that commonly include Streptococcus and Staphylococcus. As in any ‘dirty’ wound it is important to check the patient’s tetanus status and cover them as required. If you are working in a region where rabies is endemic, it is essential to check if the animal has been vaccinated for rabies and arrange vaccination if required. Some dogs have powerful jaws so bear in mind that there may be a crush element to the injury, which may further devitalise tissue or, in the worst-case scenario, precipitate compartment syndrome.
Animal Bites
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Animals bites are common reasons people seek medical attention. The most common animal bites worldwide are dog and cat bites and are estimated to be around 5%–25% and 30%–50%, respectively. Monkey bites are especially prevalent in India. Depending on the nature of the bite, the type of animal and geographical location, there is a risk of deadly complications such as rabies and tetanus. It is therefore worthwhile to consider the following.
Genital injuries in children and adolescents
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Bindu N. Patel, Diane F. Merritt
Initial management of all types of bite injuries involves extensive irrigation and debridement. Whether to repair a wound with primary closure or to allow healing by secondary intent is controversial and depends on the type of bite. Old literature regarding management of animal bites speaks of delayed closure or healing by secondary intent due to concerns about infection. However, some recent guidelines now advocate primary definitive repair of injuries, because rates of infection can be higher with delayed closure.2 Antibiotic prophylaxis should be given for large wounds and hematomas; puncture wounds; cat and human bites (which are at higher risk of infection than dog bites); bites older than 6 hours; and bites in babies, infants, and immunocompromised patients. Prophylaxis in such cases is a combination of extended-spectrum penicillin with β-lactamase inhibitors for 5–7 days.2 Furthermore, evaluation for tetanus and rabies immunization should be performed as appropriate. Patients with simple scrapes and abrasions are unlikely to benefit from antibiotic treatment.
Cat bite: an injury not to underestimate
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Amin Kheiran, Vishal Palial, Rebecca Rollett, Clare J. Wildin, Urjit Chatterji, Harvinder P. Singh
Animal bites represent an average of 1–2% of patients’ visits to the emergency department (ED) in the United Kingdom and similarly in the United States; most of these are minor injuries and often go unreported [1–3]. In the United States, cat bites represent approximately 20% of animal bites visiting ED [3]. Women are bitten by cats more frequently than men [3–6]. An estimated overall infection rate for cat bites has been reported to range between 30% and 60%, which is more than double the infection rate for dog bites [2,3]. Dog bites are mechanically destructive, blunt teeth and strong jaws result in a tearing action producing significant visual soft-tissue damage [2,4]. Cat bites are easily underestimated because of the minimal appearance of tissue injury [3,5,6]. Cats have sharp, slender teeth that penetrate deep tissues, bones and joints. Like hypodermic needles [2,6], they produce a deep puncture wound inoculated with saliva that seals off within 48 h; this leaves a potential dead space resulting in deep infections [2–8]. Therefore, the risk of deep infections is easily underestimated by the patient and the treating professional [3,6,8,9]. Clinical infection is mostly characterized by progressive inflammation causing acute onset of erythema, swelling and intense pain within 24 h of initial insult in 70% of victims and by 48 h in almost 90% of cases [9,10].
Current status of human rabies prevention: remaining barriers to global biologics accessibility and disease elimination
Published in Expert Review of Vaccines, 2019
Charles E. Rupprecht, Naseem Salahuddin
The basic approach to the bite victim is fairly standard [18–20]. The core principle of animal bite management is to rapidly and thoroughly flush out saliva, containing virus or bacteria, and lavage with soap and water. This action denatures the surface glycoprotein of virions and inactivates rabies virus. Such a simple, mechanical process reduces the risk of developing rabies by over 30%, and also flushes out soil and other debris from the wound. Topical antiseptic application can destroy accompanying bacteria, that are usually present in animal saliva. Subsequently, rabies vaccine should be administered in all suspect cases post-bite, with RIG infiltrated thoroughly into deep or multiple wounds (Figure 1). After a bite, prophylaxis for tetanus is also warranted, in tetanus-prone wounds. Antibiotics should be prescribed in cases of deep wounds, to provide coverage against the oral flora of the biting animal.
Surgical management of severe facial trauma after dog bite: A case report
Published in Acta Oto-Laryngologica Case Reports, 2020
Bernhard Prem, David Tianxiang Liu, Bernhard Parschalk, Boban M. Erovic, Christian A. Mueller
Possible tetanus infection is another important aspect to consider after animal bites. Tetanus management depends on the immunization status of the attacked person (see Table 2) [1,2,20]. If the patient has been vaccinated according to the recommended schedule at least three times, with the most recent booster administered within the last 5 years, no further steps regarding immunization are required. If the most recent vaccination was over five years ago, a booster is given. In cases where the immunization status is unclear or where the last booster was administered over 20 years ago, both active and passive immunization are recommended [1,2,19,20].