What to do...and what to worry about...when treating stings and bites.
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Three hundred twenty-seven bite injuries of the hand were reviewed for incidence of infectious complications. A policy to hospitalize all patients with human bite injuries was maintained, but noncompliance was high. Patients with uninfected or superficially infected bites (131) were hospitalized and treated with parenteral penicillin, cephalosporins, or clindamycin (mean duration, 45 hours). Among the 62 patients not lost to followup three minor septic complications occurred. Of similar patients not hospitalized (134), only two thirds received antibiotic therapy but no complications were observed. These data suggest that human bite hand infections can be averted and that established superficial infections can be successfully treated with outpatient antibiotic therapy. Of the 62 patients with moderately to severely infected human bites, 77% were injured by striking an opponent; 52% suffered injury over metacarpophalangeal joints. The mean delay in seeking medical attention was 2 1/2 days, compared to 1/2 day in the less severely infected group. Of the patients with more seriously infected bites, 94% received parenteral antibiotic therapy. Of 30 patients with known outcome in the latter group 27% suffered complications (stiffness; recurrent infection; other infectious complication), confirming the high morbidity of established deep hand infections secondary to human bites.
A case is presented of loss of half of the lower lip from a human bite. An Estlander flap was used on the fifth day for reconstruction, with no infection and a good result. This shows the advantage of a "delayed primary closure" in some of these badly contaminated wounds.
In two years, in our hospital in Nigeria, we saw 16 patients with lower lip losses caused by human bites. These are presented, together with the methods used for early management and subsequent repair.
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Only the rare practicing physician does not see at least a few patients during the warm summer months who have come off second best in an encounter with a member of Hymenoptera or one or the other of the various species of the phylum Arthropoda. Next to children and certain occupational groups such as farmers, it is probable that the outdoor sports enthusiast is the most frequent victim of insect stings and bites. Often the victim is not sure just what attacked him, and the physician may have to make an educated guess based on the appearance and grouping of the wounds and on the nature of the patient's symptoms. Usually, secondary infection is the most frequent possibility after these attacks. However, the hypersensitive patient who suffers immediate or delayed allergic reaction poses the greater, if rarer problem.
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A series of 25 cases of human bites of the facial region has been presented. Treatment procedure has been outlined for use in both infected and noninfected cases. Three case histories have been outlined.
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