Bite Injuries

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-11-27 18:19

Bite injuries can be dangerous - regardless of body site and wound size - as they can easily lead to infections. Therefore, a medical consultation is recommended even in cases in which the injury looks rather small and harmless at first glance. Most bite marks are caused by cats and dogs. In third place are human-made bite injuries.

However, serious injuries can also be caused by herbivores such as horses, donkeys and cows. Human bites often occur as part of acts of violence, less often during sports or sexual activities.

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What are the consequences of a bite injury?
How is the diagnosis made?
How are bite wounds treated?
How are the costs going to be covered?

What are the consequences of a bite injury?

An animal or human bite can cause mechanical damage as well as infection.

Mechanical bite effect

Bite injuries usually cause large-burn wounds, which can also affect the soft tissue underneath. This can damage the skin, subcutaneous tissue and deeper structures such as muscles, tendons, nerves and blood vessels, and more rarely bones or joints.

Infectious consequences

An infection occurs in five to 20 percent of all dog bites and 30 to 60 percent of cat bites. Human-made bites are more prone to infection than dog bites and are more likely to cause infection complications of deep-seated tissue. Virus infections such as hepatitis B, hepatitis C, or HIV can also be transmitted through human bites. The pathogens usually come from the mouth of the causer (staphylococci, streptococci, anaerobes), sometimes from the victim's skin or from the environment.

Due to the bite, the highly germ-colonized oral flora of humans or animals can get into deeper layers of tissue. In particular, the long, slender teeth of the cat “inoculate” the germs deep under the skin surface. The mechanical damage also impairs the blood flow to the affected tissue and consequently the defense against infection. This can lead to a local infection. The course of the tendon sheaths on the hand has anatomically predetermined ways of spreading deep infections, which can quickly include regions of the hand that are far from the bite.

In the case of a generally weakened immune system, particularly infectious pathogens (e.g. Pasteurella or Capnocytophaga canimorsus) or delayed treatment, the infection can spread throughout the entire organism and in the worst case lead to potentially life-threatening sepsis.

In Austria, rare consequences of bite injuries are infections with tetanus and rabies. The latter has been eradicated in Austria, but not in Eastern and Southeastern European countries. It cannot be ruled out that dogs imported from these areas are infected. There is also a certain risk of infection when traveling.

How is the diagnosis made?

First, the course of the accident is discussed in the anamnesis. In a physical examination, the doctor determines whether there have been injuries to muscles, nerves or blood vessels. If there are signs of an advanced local infection (e.g. reddening, swelling, fluctuation, accumulation of pus or dead tissue), swabs are taken from the wound and a pathogen culture is created to identify the germs. If a systemic infection is suspected (e.g. in the case of fever or poor circulation), a blood count and blood cultures follow. If necessary, further examinations may be necessary, e.g. X-rays or angiography. Photos of the bite wound can be useful for forensic purposes.

How are bite wounds treated?

It is important to use first aid measures for acute bite injuries.

Medical treatment depends mainly on the location and depth of the wound and the extent of the infection. In general, it is advisable to immobilize the injured body part. A booster or re-vaccination against tetanus is mandatory. Prophylaxis is recommended if rabies is suspected. For more information, see Rabies Vaccination.

Superficial wounds without severing the dermis: Disinfection with conventional means and a sterile bandage are usually sufficient. The use of the occasional recommended washing out with water is rather controversial.

Deeper bite injuries:

The question of whether and at what point in time wound closure makes sense is discussed inconsistently among experts. Basically, there is agreement that infected wounds and wounds that are more than six hours old = " and / or have a high risk of complications (e.g. particularly large or deep wounds) are usually left open. In particular, if the wound is fresh - ie only a few hours old = " - and there are no signs of infection, some doctors believe that after cleaning and wound sanitation, wound adaptation can be considered. The wounds are only closed loosely so that any secretion can escape and does not remain in the wound.
The treatment of bite wounds in cosmetically problematic regions (e.g. face, genital area) or in the event of functional impairment (tendon / nerve injuries) should be reserved to doctors for (accident) surgery or plastic surgery.
Wounds that are associated with complications such as broken bones, joint involvement, loss of large parts of tissue or injuries to deep anatomical structures require accident, neurosurgical or orthopedic treatment.

When are antibiotics useful?

Prophylaxis for non-infected bite wounds

It is still not clear whether and in which cases prophylactic antibiotics are useful and effective. It should be considered in patients with an increased risk of infection (e.g. immunosuppression, diabetes, removed spleen, cirrhosis) or increased signs of infection.

Under certain circumstances, prophylaxis over three to five days can be useful, e.g. for:

immunodeficiency

wounds that are only a few hours old, particularly deep or poorly located (e.g. near the joint or on the hand), high risk of infection.

Therapy for infected or complicated bite wounds

With adequate antibiotic therapy, infected, uncomplicated wounds in healthy people usually heal within five to ten days. Any infected wound must be checked after 24 to 48 hours.
Intravenous antibiotic administration (usually for a maximum of 14 days) is particularly necessary in the case of: General symptoms such as fever or poor circulation or people with weakened immune systems.
Intravenous therapy in the hospital should include: multiple or complicated bite injuries, severe local or systemic infection, joint or bone involvement and patients with severe underlying diseases or a weakened immune system. A treatment period of up to six weeks may be required.

Whom can I ask?

The following bodies are responsible for the diagnosis and treatment of bite injuries:

Doctor for trauma surgery
General practitioner
Doctor for dermatology and venereology
Doctor for orthopedics
Doctor for surgery
Emergency room

In the event of a serious bite injury, call the ambulance at 144.

How are the costs going to be covered?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB).

However, you can also use a doctor of your choice (i.e. doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.

When hospitalization is required

Hospitalization may sometimes be required for treatment. The hospital costs are billed for. The patient has to pay a daily contribution to the costs. Further medication treatment at home takes place by prescription from the general practitioner or specialist.