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Original articles: Francis P Henry, Elizabeth M Purcell, and Patricia A Eadie The human bite injury: a clinical audit and discussion regarding the management of this alcohol fuelled phenomenon Emerg Med J 2007; 24: 455-458 [Abstract] [Full text] [PDF]

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The Importance of Irrigation

Daniel G Boden   (29 June 2007)

The Importance of Irrigation 29 June 2007
Daniel G Boden, Emergency Registrar New Cross Hospital, Wolverhampton Send letter to journal: Re: The Importance of Irrigation danboden77{at}hotmail.com Daniel G Boden	Dear Editor, I read with interest the article and discussion on human bite injuries by Henry et al (EMJ 2007; 24:455-458). I would like to make reference to the particular importance of irrigation and debridement of any such wound involving dental flora, as well as the high index of suspicion required in an often unreliable cohort of patients. We recently had a patient present to our department with a delayed presentation (two weeks) of a metacarpal injury to his dominant hand following a dental-related closed fist injury. He had a fluctuant swelling over his third metacarpal head and an extensor lag of 10-15 degrees (although, surprisingly, otherwise normal range of movement). Clinical suspicion resulted in exploration in theatre and evidence of both extensor tendon damage and a significant septic arthritis. This resulted in thorough intra-articular and soft tissue irrigation as well as a degree of surgical debridement. Unfortunately, as an oversight, antibiotics were prescribed but not dispensed and the patient was discharged without formal antimicrobials. On reviewing the gentleman on day three he was making excellent clinical progress and the decision was made to closely monitor and continue to withhold antibiotics. He continued to make good clinical progress and made an excellent recovery with full functional capacity. Despite a significant septic arthritis this patient required no antimicrobials and highlights once again the importance of meticulous irrigation and debridement in the management of these cases.