Management and outcomes of mammalian bite injuries during COVID-19 and implications for future practice

Abstract

Mammalian bites are common injuries, but management has been shown to vary widely. The aim of this study was to assess how the COVID-19 pandemic impacted management of mammalian bite injuries and resulting outcomes. We conducted a retrospective review of prospectively collected data on mammalian bite injuries assessed in our Plastic and Reconstructive Surgery department during April and May 2020. 37 patients presented with mammalian bite injuries during this period. Median age was 27 (range 1-75) with equal gender distribution. The majority presented on the day or day after injury. Bites were from dogs (78%), humans (14%) and cats (8%). Body parts involved were finger/hand (21), face (8), arm/forearm (5) and thigh/leg (3). 6 wounds were superficial (i.e. not penetrating the full-thickness of the skin) and 4 were associated with a fracture or significant soft tissue damage. 30 out of 31 non-superficial injuries were washed out under local anaesthesia, patients received a tetanus booster (if required) and were discharged with oral antibiotics and safety net advice. One wound associated with extensor tendon injury and metacarpal fracture was admitted and treated in the operating theatre. No complications were registered and only one patient represented with an infected wound, which was washed out under local anaesthesia and the patient discharged. Our experience during the COVID-19 pandemic suggests that the majority of mammalian bite injuries can safely be managed with washout under local anaesthesia, oral antibiotics and discharge on the same day with safety net advice. Going forward, healthcare resources can be optimised by taking these results into account.

Re “Management and outcomes of mammalian bite injuries during COVID-19 and implications for future practice”

“…We read with interest the article by Chicco et al 1 . We write to request some clarifications and comment on this paper.…”

“…A missed open joint or breached flexor sheath might result in a significantly more complex intervention and a more prolonged recovery if infection develops. Chicco et al 1 did not comment on the seniority of surgeon undertaking the debridement/washout. During the height of the COVID pandemic, many units had senior registrars and consultants being deployed to manage minor injuries.…”

Response to chicco et al. communication entitled ‘Management and outcomes of mammalian bite injuries during COVID-19 and implications for future practice’ Published: November 07, 2020DOI:https://doi.org/10.1016/j.bjps.2020.10.090

“…In our department we have experienced a similar trend of managing bites wounds more conservatively as a result of the Covid-19 pandemic in our Plastic Surgery Unit at the Royal Free Hospital, London. 1 …”