Rationale:

• Bites to the hand and puncture wounds allow deep inoculation of bacteria and are the most likely bites to become infected.
• Most cat bites occur on the upper extremities, whereas facial bites are common in children bitten by dogs.
• Damage to ligaments, tendons, bones, and underlying vascular structures need to be identified at presentation to facilitate proper management.
• Clenched fist injuries, caused by punching another individual in the teeth, result in the highest risk of infection due to deep inoculation caused by extending the hand after inoculation with a flexed fist, small superficial wound, and delayed presentation.
• Wounds with evidence of active infection require antibiotics to prevent loss of function or amputation.

Evidence:

• Approximately 40% of dog bites to the hand and dog bite puncture wounds become infected, according to one review article (3).
• Of 107 consecutive patients presenting with infected cat and dog bites, 85% of infected cat bites and 60% of infected dog bites were caused by puncture wounds (19).
• A prospective randomized controlled trial of antibiotic prophylaxis for human bites to the hand revealed an infection rate of 47% in the placebo arm (22).
• Of 100 consecutive clenched fist injuries seen at one institution in South Africa, 18 required amputation (23).

Comments:

• None.