Is surgical debridement of a human bite wound necessary?
Date First Published:
July 6, 2005
Last Updated:
July 15, 2005
Report by:
Miss Tanzeem Iqbal, Medical Student (Manchester Royal Infirmary)
Search checked by:
Dr Bernard Foex, Manchester Royal Infirmary
Three-Part Question:
In [adults with a human bite] does [surgical debridement] prevent [infection]?
Clinical Scenario:
A 31 year prison warden presented to the emergency department with a human bite wound to his leg after a quarrel with an inmate. There was deep puncture of tissue and a lot of blood. Pain releif and tetanus immunisation was given. After the wound was cleaned you want to know whether surgical debridement reduces the risk of infection.
Search Strategy:
MEDLINE - 1966 -06/05 and EMBASE -1988 06/05 using the OVID interface.
Search Details:
human bite$.mp. or exp Bites, Human/ AND [debridement.mp. or exp DEBRIDEMENT/exp Debridement/ or debride.mp.OR exp Irrigation/ or irrigate.mp.] AND [exp INFECTION/ or exp WOUND INFECTION/ or infection.mp.] LIMIT to human AND English language.
Outcome:
39 papers were found on MEDLINE and 44 papers on EMBASE. Altogether 3 papers provided the best evidence for the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Management of early human bites of the hand: Zubowicz V N, Gravier M, a prospective randomised study 1990 Atlanta | 48 adult patients with human bites to the hand. Inclusion criteria were: Bite less than 24 hours old, bites not infected and absence of systemic infection, and bites not penetrating a joint capsule or injuring a tendon. | Prospective Randomised study (A PRS) | Infection: Antibiotics plus debridement vs no antibiotics plus debridement | 0/33 vs 7/15 | Open mouth wounds predominated clench fist injuries |
| Human bites of the face: Chidzonga M.M, A review of 22 cases. 1998 Zimbabwe | 22 consecutive patients with human bites of the face. Antibiotics given and primary closure of the wound in all patients. |
Prospective study | Wound infection following surgical debridement | 1 infection (5%) in the whole group, vs 21 (95%) patients with no infection | The study mainly looked at black females, and majority (90.9%) were lower lip bites. Antibiotics were given to all patients and no comparison of no antibiotic vs antibiotics. |
| Human Bites of the Hand: the Tasmanian experience, Tonta K and Kimble F W, 2001 Australia | 35 males with human bites mainly with clench fist injuries. | A 5 year retrospective study | Return to full motion after injury | 41% full range of motion after debridement | This study used a small number of subjects. The study concentrates on time of presentation and many patients were lost to follow up. |
Author Commentary:
Zubowicz et al showed that early presentation, and surgical debridement, in combination with antibiotics reduced the risk of wound infection. It is not known whether debridement without antibiotics is effective in reducing wound infection in this study.
Chidzonga et al focused on wounds to the face. This study found that debridement and daily wound care are insufficient without prophylactic antibiotics.
Tonta et al showed that debridement increased the return to full range of motion of the hand. It is more likely that no infection is present in order to regain full range motion.
Chidzonga et al focused on wounds to the face. This study found that debridement and daily wound care are insufficient without prophylactic antibiotics.
Tonta et al showed that debridement increased the return to full range of motion of the hand. It is more likely that no infection is present in order to regain full range motion.
Bottom Line:
Surgical debridement of bite wounds is insufficient without antibiotics. Antibiotics are effective in preventing infection.
References:
- Zubowicz V N, Gravier M, a prospective randomised study. Management of early human bites of the hand:
- Chidzonga M.M, A review of 22 cases.. Human bites of the face:
- Tonta K and Kimble F W,. Human Bites of the Hand: the Tasmanian experience,