Primary closure of mammalian bites

Abstract

Objective: Suturing of bite wounds remains controversial. The authors evaluated the incidence of wound infection in 145 mammalian bite wounds treated with primary closure. Methods: Consecutive patients with bite wounds receiving primary closure at a university hospital ED had structured closed- question data sheets completed at the time of wound management and suture removal. Infection was determined at the time of suture removal using a previously validated definition. Data included demographics; medical history; time from injury to evaluation; wound characteristics and location; details of wound cleansing methods, debridement, foreign body removal, and wound closure methods; use of antibiotics; and follow-up wound evaluation. Proportions and 95% confidence intervals were calculated. Results: One hundred forty-five mammalian bite patients were enrolled: 88 dog, 45 cat, and 12 human bites. Patients had a mean (±SD) age of 21 ± 20 years; 58% were male; 86% were white; and they presented a mean (±SD) of 1.8 ± 1.2 hours after injury. Bites occurred on the head and neck (57%), upper extremity (36%), and lower extremity (6%). Wounds had a mean length and width of 2.5 cm and 4.8 mm, respectively. Twelve percent involved structures deep to subcutaneous tissue. After primary wound closure, wound infections occurred in eight patients (5.5%; 95% confidence interval = 1.8% to 9.2%). Conclusions: The data suggest that carefully selected mammalian bite wounds can be sutured with approximately a 6% rate of infection. This infection rate may be acceptable in lacerations where cosmesis is a primary concern.