Laboratory Studies
- No laboratory studies are required unless bacteremia or sepsis is suspected.
- If indicated, draw appropriate baseline viral titers from the patient and the assailant.
Imaging Studies
- Radiography may be useful, particularly in hand injuries or over bone, to reveal fractures, foreign bodies (tooth fragment), or air within a joint.
- Radiography of chronic wounds may reveal underlying osteomyelitis.
Other Tests
- Routine culture of all human bite wounds is unnecessary because they are costly, demonstrate no growth in more than 80% of cases, and rarely alter first-line therapy.
- Wounds subsequently manifesting signs of infection often have bacteriologic profiles differing from the initial cultures.
- Wound cultures are indicated in wounds manifesting signs of infection (eg, cellulitis, swelling, purulence) and in wounds not showing clinical improvement despite seemingly appropriate antimicrobial therapy.
- Obtain and grow aerobic and anaerobic cultures for 7-10 days to identify slow-growing pathogens. This allows quantification and identification of bacterial species and their antibiotic susceptibilities. If possible, obtain cultures prior to the initiation of antimicrobial therapy.
Procedures
- Meticulous wound care is the cornerstone of human bite wound management.
- Copious irrigation decreases the incidence of wound infection.
- Use isotonic sodium chloride solution, dilute povidone-iodine (Betadine), or dilute hydrogen peroxide to thoroughly cleanse the wound.
- Cleansing is best performed with a 10-mL syringe with an 18-gauge angiocatheter attached.
- Take care to avoid injection of the tissues and to prevent additional trauma.
- Careful debridement of devitalized tissue, particulate matter, and clot is also necessary to reduce the infection risk and to improve the cosmetic result.
- Faster wound healing and better scarring result from clean, surgically created wound margins.
- Wound closure is a source of controversy in the management of patients with human bite wounds.
- In general, do not close hand wounds, puncture wounds, infected wounds, and wounds more than 12 hours old. Allow such wounds to heal by secondary intention. They may be closed secondarily or revised at a later date.
- Head and neck wounds, being in a cosmetically sensitive area, may be closed if they are less than 12 hours old and not obviously infected. These wounds have been closed with a low incidence of infection, probably because of excellent blood supply and infrequency of edema.
- The following points deserve specific mention:
- Antibiotic prophylaxis is mandatory in these patients.[5]
- Perform closure in a simple, interrupted fashion, avoiding layered closure with buried sutures.
- The objective is to provide wound edge approximation that is not watertight and still allow for drainage.
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