title: Thorough debridement and immediate primary wound closure for animal bite injuries of the upper limbs.
abstract: OBJECTIVE
  Animal bite injuries are often encountered in daily practice. In particular, these injuries of the upper limbs can result in severe functional impairment. We have performed early debridement of contaminated tissue and primary closure for these injuries.
  
  
  METHODS
  The subjects consisted of 15 patients (6 males and 9 females) aged 1-91 years (mean 53.6 years) who visited our hospital due to animal bite injuries (dog in 9 patients, cat in 6). The bite site was the forearm in 5 patients and the hand in 10. In the operating room, contaminated tissue was removed, and primary wound closure was performed after irrigation.
  
  
  RESULTS
  The bite penetrated to the muscle layer in 6 patients, tendon sheath in 5, joint in 1, bone in 1, and involved only the subcutaneous tissue in 3 patients. The mean period until the completion of wound treatment was 19.8 ± 8.4 days. As complications, numbness of finger, metaphalangeal joint contracture and superficial radial nerve injury were observed in each one case. In a patient with bite injury of the palmar and dorsal sides of the thumb reaching the bone, additional debridement was necessary. At the final observation, the visual analog scale was 1.2 ± 1.4, and the Quick Disabilities of the Arm, Shoulder, and Hand score was 9.7 ± 12.2.
  
  
  CONCLUSIONS
  Debridement to achieve wound closure is indispensable in patients with animal bite injuries of the upper limbs. The results of our study suggest that thorough debridement allows primary closure, even for animal bite injuries.
authors.affiliation: Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. knaito@juntendo.ac.jp.|Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, Shizuoka, Japan. knaito@juntendo.ac.jp.
authors.forename: K
authors.initials: K
authors.lastname: Naito
authors.affiliation: Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, Shizuoka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Sugiyama
authors.affiliation: Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, Shizuoka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Igeta
authors.affiliation: Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kaneko
authors.affiliation: Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, Shizuoka, Japan.
authors.forename: O
authors.initials: O
authors.lastname: Obayashi
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001733:Bites and Stings / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D001133:Bones of Upper Extremity / Q000293:injuries*; D002415:Cats; D003286:Contracture / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D003646:Debridement / Q000009:adverse effects / Q000379:methods; D004285:Dogs; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D017695:Soft Tissue Injuries / Q000150:complications / Q000209:etiology / Q000601:surgery; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome; D034941:Upper Extremity / Q000293:injuries*; D058106:Wound Closure Techniques / Q000009:adverse effects*; D014946:Wound Infection / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents
keywords: Animal bite injuries; Immediate primary wound closure; Thorough debridement; Upper limbs