Irrigation is a key means of infection prevention. A 19-gauge blunt needle and a 35-mL syringe provide adequate pressure (7 psi) and volume to clean most bite wounds. In general, 100-200 mL of irrigation solution per inch of wound is required. [17] Heavily contaminated bite wounds require more irrigation. Large dirty wounds may require irrigation in the operating room. If available, povidone-iodine solution has been shown to be virucidal and is recommended for irrigation by the US Centers for Disease Control (CDC) if there is concern for rabies. A 10% solution can be diluted (10 or 20:1) and used to both cleanse the surface of the wound as well to irrigate. [18] Additionally, isotonic sodium chloride solution or tap water are safe, widely available, effective, and inexpensive irrigating solutions. Few of the numerous other solutions and mixtures of saline and antibiotics have any advantages over tap water or saline. [17] If a shieldlike device is used, take care to prevent the irrigating solution from returning to the wound, which may decrease the effectiveness of the irrigation.
It may be difficult to appropriately irrigate small puncture wounds, especially those inflicted by the teeth of a cat. Given that these have a higher rate of infection, consideration should be given to opening the wound with a No. 15 scalpel and creating a 1- to 1.5-cm incision that can be well irrigated and left open to heal by secondary intention. [19]
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Animal bites. The devastating damage sustained by a preadolescent male during a dog attack. Almost lost in this photograph is the soft tissue damage to this victim's thigh. This patient required 2 units of O- blood and several liters of isotonic crystalloid. Repair of these wounds required a pediatric surgeon, an experienced orthopedic surgeon, and a plastic surgeon. Attacks such as these have caused a movement in some areas of the country to ban certain dog breeds.
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Animal bites. Massive soft tissue damage of the right leg caused by a dog attack. This patient was transferred to a level one pediatric trauma center for care. At times, staff members may need counseling after caring for mauled patients.
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Animal bites. Massive soft tissue damage of the lower left leg caused from a dog attack. Most of the fatalities from dog bites are children.
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Animal bites. A different angle of the patient in Image 3 showing the massive soft tissue damage to this child's left lower leg.
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Animal bites. Wounds to the left arm and hip inflicted during a dog attack.
