Consequential damages and aftercare following a dog bite to a hand

What is important when providing aftercare to a hand that incurred a dog bite?

The biggest risk associated with a dog bite injury to a hand is the one of the recurring infection. This risk of a recurring infection does not just persist over the first few days but continues to represent a potential threat for weeks. This is particularly true if the infection travelled into a bone or joint of the hand or if it damaged a tendon.

What needs to happen in the event of a recurring infection?

In the event of a recurring infection, immediate surgical action has to be taken. The newly developing suppurative source has to be surgically removed along with any necrotic or severely ischemic tissue in order to eliminate the breeding ground for the infection.

Proper irrigation of the entire wound area to reduce the bacterial count is just as imperative during the revision surgery.

Bite wounds in the joint area present a particularly high risk for infectious relapse.

The joint cavities are hard to reach during surgery.

What could be the consequences arising from a dog bite injury?

In very severe cases where the infection spread out to the back of the hand, necrotizing skin and fatty tissue infections are frequently observed. These soft tissue defects may add on to the complications by also leaving tendons or bones exposed.

What has to happen in case of a large soft tissue defect?  

As long as the tendons, bones or joints do not lay exposed, the defect may be covered through a split skin graft.

If tendons, bones or joints are affected and do lay exposed, oftentimes complicated skin grafts need to occur, which are geared towards the transplantation of large skin-flaps along with their blood vessels. These interventions are very sophisticated and are typically handled by specialized departments only.

What happens to the mobility of a hand which incurred an infectious dog bite wound?

Many times in severe cases, soft tissue infections due to dog or cat bites will lead to mobility malfunctions.

The primary reason for these malfunctions is extensive adhesions within flexor or extensor tendons or even within the concerned articular capsule. Mobility malfunctions after a dog bite may very well compromise the entire function of a hand.

What can be done to improve mobility in a hand compromised by an infectious dog bite?

It is very important to quickly start with physiotherapeutic or ergo therapeutic measures just as soon as it becomes obvious that the mobility of the hand may be compromised. This may help reduce the severity of the malfunction. Once the malfunction is established, revision surgery may be advisable.

What happens during a revision surgery procedure? 

In a case like that the extensive adhesions and many times also contracture scars will be released to facilitate the gliding process of the tendons.

What results may be expected from such revision surgery procedure?

In many cases a revision surgery as result of a dog bite injury unfortunately does not lead to a complete normalization of the hand function. This has to do with a peculiarity associated to dog bite injuries:

The dog bite injury oftentimes is not limited to the direct damage of tendons, bones and joints. Oftentimes it also involves the tissue through which the tendons glide, which may get damaged through the actual bite or the infection resulting thereof.  To be very clear on this: a dog bite and a subsequent infection many times lead to irreversible damages to the synovial membrane tissue.

Releasing tendon adhesions at a later time does usually not allow for full restoration of damaged tendon sheath synovial membrane tissue. Therefore a tardy surgical intervention performed on the tendons (tenolysis) may lead to an improved mobility but not to a full mobility restoration.

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