Chapter 6: Plastic Surgery. - Famona Site

Hand bites tend to present in different ways:- fresh wounds- cellulitis- sepsis like- abscesses (finger or hand)- tendon sheath infection- arthritis- gangrenous finger, skin or sometimes whole hand- toxicity and severe pain.In my experience more than 90% of hand bites present with either cellulitis or sepsis.ManagementSome patients may not reveal the nature of the cause because of the embarrassingnature of being bitten. A good history is essential for establishing, among other things, thetime interval between bite and presentation as this may alter the management. Attentionshould be paid to the general care of an injured patient for airway, breathing or circulationcheck.Furthermore, a detailed general examination should be done to confirm or exclude:- diabetes- alcoholism- steroid therapy and- depressed immunity, as these will adversely affect the result of treatment.Local examination should then be done to determine the extent of the damage, and thetype of wound.Intact skin is relatively easy to handle. The abrasions and contusions are simplycleaned with an antiseptic solution. The pain is relieved by analgesics.An aggressive approach should be followed for open wounds to prevent sepsis and toprovide good functional and cosmetic result.In both face and hand injuries the initial phase of wound management is thoroughcleansing, including the surrounding area.Wound irrigation, which should be copious, remains the mainstay in the earlymanagement of bite wounds. The solution to be used is still a point of contention. Ideally oneneeds a solution with antiseptic and detergent properties without harming the tissue. There aremany on the market, the effect of which still need scientifically controlled studies. It isgenerally said that you must not put in a wound what you cannot put in the eye. Normalsaline, though it lacks these properties, is still widely used. Plasmalyte may be a betterphysiological solution.19