Rationale:

• Closure of infected bite wounds will not allow healing to occur and increases morbidity.
• Puncture wounds cause deep inoculation of bacteria and carry a higher risk of infection than bite lacerations.
• Wounds that are presented late carry a higher risk of infection.
• Mammalian hand bites carry a higher risk of infection compared with bites of other body parts.
• Facial bite wounds carry a lower risk of infection partially due to the excellent blood supply and the lack of dependent edema of the head.
• Facial wounds that are closed primarily tend to have a better cosmetic outcome than wounds that heal by secondary intention.
• Low-risk bite wounds, assessed by emergency department physicians, can be closed primarily with a low rate of infection.

Evidence:

• In a meta-analysis of antibiotic prophylaxis for mammalian bite wounds, the overall infection rate of puncture wounds was 20%, whereas the infection rate for lacerations was 4.5% (39).
• In a prospective study of 100 human “fight-bite” injuries of the hand, the time until admission of the 18 patients who ultimately required amputation was 9.2 days in comparison to 4.6 days in those with healing without amputation (23).
• A prospective uncontrolled cohort study of primary closure of 145 mammalian bite wounds (88 dog, 45 cat, 12 human) revealed an infection rate of 5.5%, comparable to the 3.4% rate of infection of non-bite lacerations repaired primarily (40).
• A study of 30 consecutive patients with human facial bite injuries closed primarily revealed an infection rate of 10% (41).
• Primary closure of 188 consecutive head and neck dog bite wounds revealed a wound infection rate of 1.4% and a patient infection rate of 4% (36).
• 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 from the infection rate in nonrepaired wounds of 1.9% (37).
• A retrospective study of 118 patients admitted to a hospital with dog bite injuries treated with primary closure showed an overall infection rate of 2.5% (6).

Comments:

• None.