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Wound closure in animal bites
  1. Freya Garbutt, Specialist Registrar,
  2. Rachel Jenner, Specialist Registrar
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether primary closure of animal bites increases wound infection rates. Altogether 74 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated

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    Report by Freya Garbutt,Specialist RegistrarChecked by Rachel Jenner, Specialist Registrar

    Clinical scenario

    A patient presents to the emergency department having been attacked by a dog. He has sustained lacerations to his hand and face. You provide oral analgesia, ensure he is covered for tetanus, and thoroughly clean and irrigate the wounds under local anaesthesia. The patient asks you to close the wounds and you wonder if there is any evidence that this would increase the rate of infection.

    Three part question

    In [adult patients with animal bites] does [wound closure] increase the [risk of infection]?

    Search strategy

    Medline 1966-05/04 using the OVID interface. [exp“bites and stings” OR bite.mp] AND [suture.mp OR exp sutures OR steristrip.mp OR exp adhesives OR glue.mp] LIMIT to human AND English language.

    Search outcome

    Altogether 74 papers were found of which one provided the best evidence to answer the clinical question (see table 4).

    Table 4

    Comment(s)

    Only one PRCT has been performed to directly investigate infection rates in animal bite wounds treated by primary closure compared with non-closure. No antibiotics were used in this study. It excludes puncture wounds, wounds infected at presentation, wounds with other structures involved, and those requiring plastic surgery. The study concludes that there is no significant difference in infection rates between the two groups except in those wounds occurring to the hands. Significantly more hand wounds became infected than wounds elsewhere, and of all hand wounds significantly more became infected in the group treated by closure. The study also noted that a delay to presentation of more than 10 hours was associated with an increased risk of infection but the relevant raw data are not presented.

    CLINICAL BOTTOM LINE

    Bite wounds to the hand should be left open. Non-puncture wounds elsewhere may be safely treated by primary closure after thorough cleaning.

    Report by Freya Garbutt,Specialist RegistrarChecked by Rachel Jenner, Specialist Registrar

    References

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