Rationale:

• Frequent return visits are essential to ensure proper wound healing and to evaluate for infectious complications.
• Follow-up of individuals being managed as outpatients can reinforce adherence with wound care and antibiotic therapy.
• Wounds closed primarily need to be assessed early for evidence of infection and to ensure removal of staples or sutures.
• Hand bites carry a high risk of infection, and it is imperative to identify infection early to lower morbidity.
• Early physical therapy decreases joint stiffness and improves functional status.
• Although rare, transmission of HIV and HBV through human bite wounds has been documented and needs to be confirmed serologically in the months after a high-risk bite wound.
• Children who are victims of dog bites, especially when associated with multiple wounds, frequently have symptoms of posttraumatic stress disorder months after the attack.

Evidence:

• A study of 30 consecutive patients with human facial bite injuries closed primarily revealed an infection rate of 10% (41).
• The rate of wound infection in 91 consecutive sutured dog bite wounds (57 head and neck, 16 upper extremity, 15 lower extremity, 3 trunk) was 4.4%, not significantly different but higher than the infection rate in nonrepaired wounds of 1.9%, according to one prospective study of 734 consecutive dog bite victims presenting to an emergency department (37).
• A case report of HIV transmission from a human bite wound documented seroconversion 54 days after exposure following zidovudine prophylaxis (73).
• A study of 22 childhood victims of dog bites showed that 12 had symptoms of posttraumatic stress disorder 2 to 9 months after the bite (74).

Comments:

• None.