eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Trauma

Human Bites: Follow-up

Author: Ian K McLeod, MD, Assistant Professor, Department of Surgery, Uniformed Services University of the Health Sciences; Chief, Otolaryngology Service, DeWitt Army Community Hospital
Coauthor(s): Daniel J Gallagher III, MD, Attending Surgeon, Department of Otolaryngology, Walter Reed and DeWitt Army Hospitals; Don R Revis Jr, MD, Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine; Michael Brent Seagle, MD, Associate Professor, Division of Plastic Surgery, University of Florida College of Medicine; Consulting Staff, Florida Surgical Center
Contributor Information and Disclosures

Updated: May 21, 2008

Follow-up

Further Inpatient Care

  • Some patients require hospitalization for the administration of intravenous antibiotics and observation or for surgical intervention. Inpatient observation facilitates prompt surgical intervention if no improvement is noted or the clinical situation deteriorates.
  • Indications for hospitalization are as follows:
    • Injuries of severity requiring surgical exploration or complex wound closure; clinical situation dictates length of stay
    • Systemic manifestations of infection (eg, fever, chills, elevated WBC count)
    • Substantial comorbidity
    • Failure to improve with initial outpatient management
    • High likelihood of noncompliance (eg, emotionally disturbed, mentally handicapped, chronic alcoholism, homeless)

Further Outpatient Care

  • Patients evaluated early and without evidence of infection may be treated as outpatients without antibiotics.
  • Follow-up should be done within 48-72 hours for reassessment.
  • Development of any signs or symptoms of infection indicate the need to seek immediate medical attention.
  • Patients with mild-to-moderate infections who are likely to be compliant may be treated as outpatients with oral antibiotics. Instruct these patients to return for follow-up within 24-48 hours and to seek medical attention immediately if their clinical condition deteriorates.

Complications

  • Complications may result from scarring or infection and include the following:  
    • Cosmetic deformity resulting from wound contraction
    • Osteomyelitis
    • Abscess formation
    • Transmission of disease (eg, hepatitis B or C, HIV) 

Patient Education

  • Patients should be informed about and fully understand the following:
    • Signs and symptoms of wound infection that require immediate reevaluation (eg, fever, odor, drainage, purulence, swelling, cellulitis, warmth, pain, decreased range of motion, any other abnormal sign or symptom)
    • Importance of early and regular follow-up for this seemingly minor injury and the potential complications that may develop, even with complete compliance with the care plan
    • Rationale for providing antibiotics and the importance of compliance
  • Inform patients that wound revision for cosmetic or functional purposes may be indicated at a later date.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education article Human Bites.

Miscellaneous

Medicolegal Pitfalls

  • Cases of human bite wounds frequently involve the legal and judicial system, have an increased likelihood of infection, and have a significant rate of permanent functional or cosmetic deformity.
  • The patient chart must appropriately document initial evaluation and treatment, a legitimate care plan, and evidence of relevant patient education.  Photographic documentation should also be considered.
  • Most jurisdictions require medical professionals to report suspected child abuse.
 


More on Human Bites

Overview: Human Bites
Differential Diagnoses & Workup: Human Bites
Treatment & Medication: Human Bites
Follow-up: Human Bites
References
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References

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  2. American Academy of Pediatrics Committe on Child Abuse and Neglect, American Academy of Pediatric Dentistry. Guideline on oral and dental aspects of child abuse and neglect. Pediatr Dent. 2005-2006;27(7 Reference Manual):64-7. [Medline].

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Further Reading

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Keywords

human bites, bite wounds, Eikenella corrodens, E corrodens, human bite wounds, occlusive bites, hepatitis B, bites, wound infection, clenched-fist injuries, bite infection, human saliva

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Contributor Information and Disclosures

Author

Ian K McLeod, MD, Assistant Professor, Department of Surgery, Uniformed Services University of the Health Sciences; Chief, Otolaryngology Service, DeWitt Army Community Hospital
Ian K McLeod, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Daniel J Gallagher III, MD, Attending Surgeon, Department of Otolaryngology, Walter Reed and DeWitt Army Hospitals
Daniel J Gallagher III, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American Medical Association
Disclosure: Nothing to disclose.

Don R Revis Jr, MD, Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine
Don R Revis Jr, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Michael Brent Seagle, MD, Associate Professor, Division of Plastic Surgery, University of Florida College of Medicine; Consulting Staff, Florida Surgical Center
Michael Brent Seagle, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Plastic and Reconstructive Surgery, and Southeastern Society of Plastic and Reconstructive Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Clark A Rosen, MD, Director, University of Pittsburgh Voice Center; Associate Professor, Department of Otolaryngology and Communication Science and Disorders, University of Pittsburgh School of Medicine
Clark A Rosen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David W Stepnick, MD, Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center
David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

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