Cat bite

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
  • Microbiology (3)
      • Pasteurella sp most common. Especially P. multocida and P. septica
  • Presentation
      • Cellulitis
      • Pain
      • Swelling

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

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

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
This subpage has been reviewed by:
1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (06/02/2020)