Rationale:

• Human hand bites, especially clenched fist injuries, carry a high risk of joint and bone involvement and need to be debrided by a surgical subspecialist.
• Improper care of human hand bite infections increases morbidity and is associated with a higher risk of amputation.
• Dog bites from large dogs can cause fractures of bone, as they can exert up to 450 psi of force.
• Children are susceptible to facial bite wounds from dog bites and thus are more likely to develop facial fractures.
• Facial wounds often can be closed primarily, and a plastic surgeon can improve the cosmetic outcome.

Evidence:

• Inadequate initial surgical management of human hand bite wounds was partially responsible for amputation in 18 of 100 patients seen in an emergency department for human hand bites (23).
• Twenty-three of 24 patients admitted with osteomyelitis of the hand from human bite wounds did not have adequate surgical debridement of the wound within 24 hours of the bite (29).
• A review of all U.S. emergency department visits for dog bites over a 3-year period revealed that 73% of bites in children ages 0 to 9 involved the head, face, and neck, whereas only 30% involved the head, face, and neck in all other ages (70).
• Though the exact incidence of facial fractures occurring with dog bite injuries is unknown, it is estimated to occur in 5% or less of facial dog bite wounds (71).

Comments:

• None.