Management of bite injuries

Editor, – The article 'Management of bite injuries' (Aust Prescr 2006;29:6-8) is helpful in determining appropriate antibiotics for bites, but the most important message is that all bite wounds, other than those where there is a clear cosmetic problem such as in the face, should be treated by wound excision and topical use of povidone-iodine, providing the patient is not allergic to iodine. Under no circumstances should wounds be sutured primarily.

Unless this point is stressed unfortunately tragedies will still occur because of the inexperience of emergency doctors who feel obliged to suture all wounds that present to the emergency department.

The primary treatment of the wound is far more important than the use of antibiotics, although they are an important adjunct to management.

Chris Haw
Senior Orthopaedic Surgeon
Western Hospital
Footscray, Vic.

Dr Marion Woods and Dr Jennifer Broom, authors of the article, comment:

Our article was concerned primarily with appropriate antibiotic management of bite wounds. We reiterate that debridement of devitalised tissue and thorough irrigation of bite wounds is an essential part of management. We made the point that early surgical consultation is advised for bite wounds, particularly for hand wounds, to prevent loss of function. Early surgical consultation will also optimise the cosmetic results of treatment particularly for bites on the face.

We agree that most bite wounds should not be primarily closed unless there is a specific need. Of note, however, is a best evidence topic report of closure of bite wounds¹ stating that dog bites on the hands should be left open (primarily closed hand wounds had double the infection rate [p < 0.01]), but that non-puncture wounds elsewhere may be safely treated by primary closure after thorough cleaning (7.6% infection rate in primary closure group vs 7.7% infection rate in open group).²

Editor, – In addition to the useful information in the article 'Management of bite injuries' (Aust Prescr 2006;29:6-8), readers should be aware of the forensic implications of bite marks.

Marks made by the teeth may be inflicted either on skin or inanimate objects in cases of criminal assault, sexual assault, child abuse or homicide. Bite marks may be used as evidence in court, either to identify a perpetrator or exclude suspects.³

While prompt medical attention for bites is necessary, medicolegal consideration must also be given to correct documentation of the injury, with biological swabs for DNA testing and photographs (including scale).⁴ Without good evidence collection criminal or civil legal proceedings may be hampered.

Helen James
Forensic Odontologist
Acting Director, Forensic Odontology Unit
University of Adelaide, Adelaide