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Introduction
Introduction
- Incidence (1)
- 5%-18% of all bites
- Mechanism of injury
- Sharp, long, thin teeth causing puncture wounds that seal themselves.
- Penetrates bones and joints as well as flexor tendons. (2,3)
- 50% risk of infection
- Septic arthritis and osteomyelitis
- Cat-scratch fever
- 50% risk of infection
- Microbiology (3)
- Pasteurella sp most common. Especially P. multocida and P. septica
- Presentation
- Cellulitis
- Pain
- Swelling
assessment
assessment
- Check tetanus status
- Specific to cat bites: (1,4)
- Bite into tendon? Check for pain on active/passive mobilisation
- Bite into nerve? NV status
- Bite into joint? Assess site, ROM and tenderness on joint movement and axial loading
- Imaging:
- AP, lateral & oblique
- Foreign bodies
- Fractures
- Crush injuries
- AP, lateral & oblique
Management
Management
GENERAL (5):
- Instruct to be NBM
- Remove rings
- Give IV antibiotics (as per local guidelines)
- Pain relief
- Tetanus prophylaxis (as per local guidelines)
WOUND CARE:
- Washout the wound with running water
- If painful use local anaesthetic to allow thorough washout
- If there is cellulitis present use a pen marker to draw at the edges for progression assessment.
- Apply a suitable dressing
- 1stlayer: non-adherent eg. adaptic or atrauman
- 2ndlayer: padding eg. gauze
- Enough to hold the amount of exudate likely to come from the wound in order to prevent strike through
- 3rdlayer: tape/plaster
- Provide a high arm sling
DISCUSS WITH SENIOR
LIKELY TO REQUIRE ADMISSION
CAT-SCRATCH FEVER (1)
- Caused by Bartonella
- Papules at the initial site of infection with regional lymphadenopathy and mild coryzal symptoms
- Usually self-limiting.
- Responds well to ciproxin and doxycycline
- NOT a plastic surgery pathology. For treatment by medical team
references
references
1. Chiu TW. Stone’s Plastic Surgery Facts: A Revision Guide, Fourth Edition. CRC Press; 2018. 2. WESTLING K, FARRA A, CARS B, EKBLOM A, SANDSTEDT K, SETTERGREN B, et al. Cat bite wound infections: A prospective clinical and microbiological study at three emergency wards in Stockholm, Sweden. J Infect. 2006 Dec;53(6):403–7. 3. Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJC. Bacteriologic Analysis of Infected Dog and Cat Bites. N Engl J Med. 1999 Jan 14;340(2):85–92. 4. Green DP, Wolfe SW. Green’s operative hand surgery. Elsevier/Churchill Livingstone; 2011. 5. The British Society of Surgery for the Hand. Hand Injury Triage App [Internet]. [cited 2020 Feb 2]. Available from: handinjurytriageapp.bssh.ac.uk
Header Image: Licensed with Adobe Stock 2019
Header Image: Licensed with Adobe Stock 2019
This subpage has been reviewed by:
1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (06/02/2020)
1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (06/02/2020)
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