An analytical study of Mammalian bite wounds requiring inpatient management

Abstract

Background: Mammalian bite injuries create a public health problem because of their frequency, potential severity, and increasing number. Some researchers have performed fragmentary analyses of bite wounds caused by certain mammalian species. However, little practical information is available concerning serious mammalian bite wounds that require hospitalization and intensive wound management. Therefore, the purpose of this study was to perform a general review of serious mammalian bite wounds.

Methods: We performed a retrospective review of the medical charts of 68 patients who were referred to our plastic surgery department for the treatment of bite wounds between January 2003 and October 2012. The cases were analyzed according to the species, patient demographics, environmental factors, injury characteristics, and clinical course.

Results: Among the 68 cases of mammalian bite injury, 58 (85%) were caused by dogs, 8 by humans, and 2 by cats. Most of those bitten by a human and both of those bitten by cats were male. Only one-third of all the patients were children or adolescents. The most frequent site of injury was the face, with 40 cases, followed by the hand, with 16 cases. Of the 68 patients, 7 were treated with secondary intention healing. Sixty-one patients underwent delayed procedures, including delayed direct closure, skin graft, composite graft, and local flap.

Conclusions: Based on overall findings from our review of the 68 cases of mammalian bites, we suggest practical guidelines for the management of mammalian bite injuries, which could be useful in the treatment of serious mammalian bite wounds.

Keywords: Antibiotic prophylaxis; Bites and stings; Plastics; Wounds and injuries.

Fig. 1

Age distribution of the mammalian bite patients The injuries were randomly distributed by age.

Fig. 2

Annual distribution of the mammalian bites Almost half of the bites occurred between May and August, the warmer months in Korea.

Fig. 3

Anatomic distribution on the facial area The most frequent site of injury on the head and neck regions was the lip, followed by the cheek.

Fig. 4

A case of skin graft A 69-year-old female patient was attacked by a dog, from which she sustained a deep abrasion on the right lateral malleolar area. After surgical debridement and wet-to-dry dressing application for 2 weeks, a split-thickness skin graft was performed. The graft was well tolerated, without any complications. (A) The preoperative view before surgical debridement. (B) The postoperative view at 2 months. The scabs on the posterior area were not prematurely removed. The graft take was complete with antibiotic ointment treatment.

Fig. 5

A case of composite grafting A 30-year-old male patient sustained a dog bite wound resulting in the exposure of the right alar cartilage. Seven days after the initial debridement, the patient underwent a composite graft using the right root of the helix. (A) The initial preoperative view. (B) The immediate postoperative view. (C) The view at 2 years postoperatively.