Rationale:

• Aggressive irrigation of bite wounds decreases the number of bacteria present in the wound and aids in debridement.
• Cleansing of wounds with bactericidal and virucidal solutions such as benzalkonium chloride may decrease the risk of transmission of certain infections.
• Thorough cleansing of wounds may decrease the risk of rabies transmission.
• Devitalized tissue needs to be removed to lower the risk of infectious complications and to facilitate proper wound healing.
• Hand bite wounds may appear innocuous on the surface but involve deep structures that can become infected if not initially managed by a surgeon experienced in hand bite wounds.
• Facial bite wounds should be sutured by a plastic surgeon to improve cosmetic outcome.
• Elevation of bite wounds decreases edema and may lower the risk of wound infection.
• Early physical therapy of extremity wounds is essential to improve the rate of functional recovery.

Evidence:

• A prospective study of 49 patients with head and neck dog bite lacerations treated with irrigation and debridement alone revealed an infection rate of 4%, comparable to an infection rate of 1.4% in 55 patients treated with irrigation, debridement, and antibiotic prophylaxis (36).
• An observational study of 769 consecutive patients with dog bite wounds revealed an infection rate of 2.4% with antibiotics and 1.7% without prophylactic antibiotics, suggesting that certain low-risk dog bite wounds can be managed with irrigation and debridement alone (37).
• Animal data with experimental rabies infection in mice or guinea pigs have shown a decrease in rabies infection from 90% to 5% to 10% with cleaning of superficial wounds 3 hours after exposure with 1% benzalkonium chloride, soap, or tap water (38).
• A retrospective review of 24 patients admitted with hand osteomyelitis from human bites revealed that 23 patients did not have adequate surgical debridement by an experienced surgeon within 24 hours of the bite (29).

Comments:

• The study of head and neck dog bite wound management was underpowered to detect a significant difference in therapy. Therefore, the results are not statistically significant (36).