BITE WOUNDS OF THE HAND

Animal and Human Bites of the Hand
Bites are extremely common and can cause significant pain and other problems, especially when associated with an infection. Early recognition of warning signs and appropriate treatment are key in minimizing potential problems from the bite.

When an animal bites, bacteria from its mouth can contaminate the wound. These bacteria may grow within the wound and cause an infection. The consequences of infection range from mild discomfort to life-threatening complications.

Many factors may contribute to the infection, including the type and location of the wound, pre-existing health conditions in the bitten person that impair immunity, such as diabetes, HIV, etc., the extent of delay before treatment, the presence of a foreign body in the wound, and the animal causing the bite.

Animal Bites
There are as many as three million animal bites in the United States each year. Dogs are responsible for most animal bites in this country (up nullto 90%), with cat bites accounting for about 5% of such injuries. Other biting animals include rodents (at least 2%), rabbits, ferrets, farm animals, monkeys, and reptiles.

Animal bites to the hand most frequently occur on the fingers of the dominant hand of children between the ages of 5 and 14. Women are bitten more frequently by cats, and men by dogs. Infections occur more frequently in cat bites because cats have extremely sharp, pointed teeth that can cause deep puncture wounds. The skin usually flaps over the bite, thereby sealing off the puncture wound, precluding open drainage and allowing an infection to develop (see Figure 1).

The major concern of all bite wounds is subsequent infection. In the United States, about 1% of dog bites and 6% of cat bites require hospitalization. With swift and proper care, the prognosis is usually very good for recovery from these injuries.

Rabies is an extremely rare but fatal infection which may result from an animal bite. In the United States, unlike the rest of the world, wild animals such as bats, skunks, raccoons, and foxes spread more than 90% of rabies infection. Report animal bites to your public health department. They may ask your assistance in locating the animal so that it can be confined and observed for symptoms of rabies.

Human Bites
Human bite wounds contain very high concentrations of bacteria so the risk of infection is high. These infections can progress quickly and result in substantial complications, so early treatment is necessary (see Figure 2). Often, human bites occur when a person’s fist is driven into another’s mouth, such as during a fistfight. After the skin is broken, bacteria are seeded into the soft tissue and the ‘knuckle’ joint, which if left untreated often results in deep infection in the joint which may ultimately destroy the joint. These problems can be effectively treated by early diagnosis, intravenous antibiotics, and surgery to drain the infection out of the joint and wash it out.

Symptoms of Concern with Animal Bites to the Hand
If the bite results in swelling, redness, warmth, continued pain beyond 24 hours, pus draining from the bite wound, red streaks extending up the arm or forearm, swollen lymph nodes (“glands”) around the elbow or in the armpit, loss of mobility, loss of sensation in the hand or fingertip, fever, malaise, night sweats, or rigors, emergency treatment should be sought either in your physician’s office or the emergency room.

Treatment of animal bites
Your doctor will examine the wound and ask about contributing factors to the injury. A complete history of the bite, including the type of animal and its status (general health, rabies vaccine, behavior), the time and location of the event, circumstances of the bite, whereabouts of the animal, and pre-hospital treatment will be reviewed.

It is crucial to update your tetanus status if you have not had a booster shot within the past ten years.

X-rays may be used to identify any damage to the bones and joints or tooth fragments that may have broken off. If an infected bite to the hand goes untreated for too long, x-rays may reveal evidence of osteomyelitis, or the spread of infection to the bone.

Animal bites to the hand require meticulous cleansing. Your doctor or other medical personnel will wash the wound and might trim away any devitalized (dead) tissue, damaged skin, blood clots, or other particles that could be a source of infection. It is important to look for signs of lymphangitis, indicated by the presence of red streaks on the forearm. Your doctor will feel the inner side of the elbow for evidence of enlarged lymph nodes. When the wound is infected, a culture is obtained to identify the type of bacteria that is causing the infection and thus help determine the antibiotic that is most effective for treatment.

The use of antibiotics for animal bites depends on the particular circumstances of the injury, patient health and sensitivity to various medications, and the appearance of the wound. Some bites require the use of IV antibiotics, while others may be treated with oral medication. The presence of an underlying fracture usually dictates inpatient antibiotic treatment. If you are diagnosed as having an infection of a flexor tendon sheath or a joint, you will need hand surgery, which will need to be performed as soon as possible.

Follow-up care is crucial in the case of animal bite wounds, to ensure that infection is diminishing or has not developed, and to restore the hand as much as possible to its former condition.

Figure 1: Finger infection from cat bite

Figure 2: Wound infection of a thumb tip after a human bite.

AnimalBite.pdf

addtional information:

DOG Biting: Causes, Prevention, and Control

taken from www.peteducation.com/article.cfm?c=2+1551&aid=165 July 2009 by www.handctr.com

Holly Nash, DVM, MS

The Centers for Disease Control and Prevention (CDC), a federal agency which monitors and controls human diseases, estimates over 4.7 million people are bitten per year. This is approximately 2 percent of the U.S. population. Ten to twenty people die each year from injuries resulting from dog bites. Most of these victims are children.

In addition to physical injuries, people, especially children, can be emotionally scarred as well. It is sad, indeed, when a person who has suffered a dog bite can no longer feel comfortable around animals, and may in fact, be terrified of them. Such people lose a wonderful aspect of their lives and a chance to have a meaningful human-animal bond.

Reduce the risk of your dog biting

There is no way to guarantee that your dog will never bite someone. But you can significantly reduce the risk if you:

Spay or neuter your dog. This will reduce your dog's desire to roam and fight with other dogs. Spayed or neutered dogs are three times less likely to bite than intact dogs.
Socialize your dog. Introduce your dog to many different types of people and situations so that he or she is not nervous or frightened under normal social circumstances.
Train your dog. Participating in puppy socialization and dog training classes is an excellent way to help you and your dog learn good obedience skills. Training your dog is a family matter, and every member of your household should be involved and use the same training techniques.
Teach your dog appropriate behavior. Avoid playing aggressive games with your dog such as wrestling, tug-of-war, or 'siccing' your dog on another person. Do not allow your puppy to bite or chew on your hands. Set appropriate limits for your dog's behavior. Do not wait for an unacceptable behavior to become a bad habit, or believe your dog will 'grow out of it.' If your dog exhibits dangerous behavior toward any person, particularly toward children, seek professional help from your veterinarian, an animal behaviorist, or a qualified dog trainer. Your community animal care and control agency or humane society may also offer helpful services. Dangerous behavior toward other animals may eventually lead to dangerous behavior toward people, and is also a reason to seek professional help.
Be a responsible dog owner. Obtain a license for your dog as required by law, and provide regular veterinary care, including rabies vaccinations. For everyone's safety, do not allow your dog to roam. Make your dog a member of your family. Dogs who spend a great deal of time alone in the backyard or tied out on a chain are more likely to become dangerous. Dogs who are well-socialized and supervised rarely bite.
Err on the safe side. If you do not know how your dog will react to a new situation, be cautious. If your dog may panic in crowds, leave him at home. If your dog overreacts to visitors or delivery or service personnel, keep him in another room. Work with professionals to help your dog become accustomed to these and other situations. Until you are confident of his behavior, however, avoid stressful settings.

If your dog would bite a person:

Confine your dog immediately.
Check on the victim's condition. If necessary, seek medical help.
Provide the victim with important information. This should include your name and address, name of the dog, the date of your dog's last rabies vaccination, and the name and phone number of your veterinarian.
Cooperate with the animal control official responsible for acquiring information about your dog. If your dog must be quarantined for any length of time, ask whether he may be confined within your home or at your veterinarian's hospital (this is usually determined by the dog's rabies vaccination status). Strictly follow quarantine requirements for your dog.
Seek professional help to prevent your dog from biting again. Consult with your veterinarian, who may refer you to an animal behaviorist or a dog trainer.
Do not just give your dog to someone else if your dog's dangerous behavior cannot be controlled. Because you know your dog is dangerous, you may be held liable for any damage he does even when he is given to someone else. Do not give your dog to someone who wants a dangerous dog. If you must give up your dog due to dangerous behavior, consult with your veterinarian and with your local animal care and control agency or humane society about your options. New owners may be possible if they have a good knowledge of dog behavior and training, and are fully aware of the dog's behavior problems.

To avoid being bitten:

Be cautious around strange dogs. To avoid being bitten, never approach an unfamiliar dog, especially one who is tied or confined behind a fence or in a car. Do not pet an unfamiliar dog without the owner's permission, and make sure to let the dog see and sniff you first. Always assume that a dog who does not know you may see you as an intruder or as a threat.
Never turn your back to a dog and run away. A dog's natural instinct will be to chase and catch you. Instead, remain motionless, with your hands at your sides. Avoid direct eye contact. When the dog loses interest, slowly back away.
Do not disturb a dog while she's sleeping, eating, chewing on a toy, or caring for puppies. Be sure the dog is aware of your presence before you touch the dog - even your own. A startled dog may bite as a reflex action.
Teach children not to tease or chase dogs.
Never leave an infant or child alone with a dog.

If you are attacked:

Put something between you and the dog. Use your coat, purse, book bag, bicycle, or other object to separate yourself from the dog.
Protect your head. If you are knocked down, cover your head and ears with your hands and curl into a ball. Try not to move or scream.
Care for any wounds. Wash any wound with soap and water and seek medical attention.
Report the attack to the police or animal control agency. Try to remember as much as possible about the attack.

The happiness and safety of you, your pet, and the people around you is important to us. By responsibly taking care of your dog and educating other dog owners, you can help prevent dog bites. You can help by supporting dog bite prevention educational programs in schools, and teaching children and adults the proper way to approach unfamiliar pets and avoid being bitten.

taken from www.peteducation.com/article.cfm?c=2+1551&aid=165