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Bites - human and animal - Management
When should I close an animal bite wound?

  • Minor bite wounds suitable for management in primary care do not usually require closure.
  • Referral to Accident and Emergency for further assessment and management is usually indicated if wound closure is thought to be necessary.
  • The type of wounds that may be considered for closure include:
    • Fresh bite wounds (e.g. less than 6 hours old) where there are no risk factors for infection.
    • Bite wounds that present between 6 and 24 hours where there are no risk factors for infection. However this is controversial and currently there is no consensus of opinion.
  • Allow the following bite wounds to heal without formal closure:
    • Bite wounds over 24 hours old.
    • Infected bite wounds.
    • Deep puncture wounds.
    • Bites to the hands and feet.
Basis for recommendation
  • These recommendations are based on expert opinion from the published medical literature [DTB, 2004; Taplitz, 2004; Brook, 2005; Richardson, 2006; Kravetz, 2007]. Wound closure is a controversial issue. CKS identified one small randomized controlled trial that compared primary wound closure with leaving a bite wound open [Maimaris and Quinton, 1988]. There was no difference between the groups in the incidence of infection. However:
    • There is general agreement that infected wounds, and those first seen more than 24 hours after the bite, should be left open.
    • Some experts recommend consideration of wound closure, after irrigation and debridement, in patients presenting less than 6 hours after the injury, if there is no visible evidence of infection.
    • For bite wounds in anatomic regions where there are significant cosmetic concerns, such as the face, a primary closure approach by a plastic surgeon or other expert is often undertaken to prevent significant scarring.
    • Wounds with a high risk of complications or infection, such as hand wounds, are generally left open even in patients who present early. When closure is deemed appropriate, wound edges can be approximated but must still allow for drainage. If a joint or tendon is thought to be involved, an orthopaedic or plastic surgery consultation should be obtained.

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