Primary closure of mammalian bites

Objective: Suturing of bite wounds remains controversial. The authors evalu ated the incidence of wound infection in 145 mammalian bite wounds treated with primary closure. Methods: Consecutive patients with bite wounds receiv ing primary closure at a university hospital ED had structured closed-quest ion data sheets completed at the time of wound management and suture remova l. Infection was determined at the time of suture removal using a previousl y validated definition. Data included demographics medical history time fro m injury to evaluation wound characteristics and location details of wound cleansing methods, debridement, foreign body removal, and wound closure met hods use of antibiotics and follow-up wound evaluation. Proportions and 95% confidence intervals were calculated. Results: One hundred forty-five mamm alian bite patients were enrolled: 88 dog, 45 cat, and 12 human bites. Pati ents had a mean (+/-SD) age of 21 +/- 20 years; 58% were male; 86% were whi te; and they presented a mean (+/-SD) of 1.8 +/- 1.2 hours after injury. Bi tes occurred on the head and neck (57%), upper extremity (36%), and lower e xtremity (6%). Wounds had a mean length and width of 2.5 cm and 4.8 mm, res pectively. Twelve percent involved structures deep to subcutaneous tissue. After primary wound closure, wound infections occurred in eight patients (5 .5%; 95% confidence interval = 1.8% to 9.2%). Conclusions: The data suggest that carefully selected mammalian bite wounds can be sutured with approxim ately a 6% rate of infection. This infection rate may be acceptable in lace rations where cosmesis is a primary concern.