Plastic & Reconstructive Surgery:
Köse, Rüştü M.D.; Söğüt, Özgür M.D.; Mordeniz, Cengiz M.D.
Department of Plastic and Reconstructive Surgery(Köse)
Department of Emergency Medicine(Söğüt)
Department of Anesthesiology and Intensive Care; Harran University; Medical School; Sanliurfa, Turkey(Mordeniz)
Correspondence to Dr. Köse Department of Plastic and Reconstructive Surgery; Harran University Hospital; 63300 Sanliurfa, Turkey; firstname.lastname@example.org
Although horses are the animals most commonly involved with fatalities,1 reports about horse bites are very rare. Comparing animal bite wounds, cat bites result in punctured deep wounds, dog bites cause rather superficial abrasion and laceration type wounds,2 and horse and donkey bites provoke tissue loss wounds.3
We have performed a retrospective evaluation of 24 patients presenting with animal bites (19 horse and five donkey bites) and treated at the department of plastic surgery from 2003 to 2009. The head and neck were the most frequent bite sites (14 cases), followed by the extremities (eight cases) and the trunk (two cases).
All patients were operated on within 24 hours after admission. Wounds were first cleansed with only saline in all patients, because irrigation with antibiotic or iodine solution may increase tissue irritation. Although half of the patients' wounds were closed with primary suture after surgical débridement of crushed wound edges, the other half required surgical treatment (Table 1). Besides the patient transferred from another clinic on the seventh day after the event, in whose hand there was tissue necrosis and infection (Fig. 1), no other patient had infection. On subsequent follow-up, three patients developed minor scar complications on the cheek and the chin.
Our initial therapy in all animal bites includes copious irrigation with saline by means of a syringe with a 19-gauge needle, careful débridement of devitalized tissues, antibiotic prophylaxis with amoxicillin and clavulanic acid, tetanus and rabies prophylaxis, and early repair.
Antimicrobial therapy is indicated for bite wound infections, but the role of antibiotics in the treatment of uninfected animal bite wounds is still a subject of debate. Controversy exists regarding the use of antibiotic prophylaxis in avoiding infections after an animal bite. The indications for antibiotic prophylaxis depend on the time between the bite and its medical treatment, the type of animal, the anatomical structures involved, and the extent of the bite.2 Although wounds on hands with exposed cartilage or delayed therapy are considered at high risk for infection in animal bites and delayed primary closure is recommended, we preferred early repair by immediate primary closure in horse and donkey bites, and no infection developed (Fig. 2).
A case of anaphylaxis after a horse bite is reported.4 A deep lesion (crush injury) producing severe hematoma, fat necrosis, and muscle rupture, without an external wound, in a woman bitten on her thigh by a horse could be diagnosed only through ultrasound examination, which can be useful for evaluating the extent of crush injuries after horse bites.5 We have not seen such cases in our series.
Our experience shows the safety of primary closure for horse and donkey bite wounds, provided that careful débridement and good cleansing with antibiotic prophylaxis are also performed. An acceptable aesthetic outcome can be achieved only with early primary repair and reconstructive procedures.
Rüştü Köse, M.D.
Department of Plastic and Reconstructive Surgery
Özgür Söğüt, M.D.
Department of Emergency Medicine
Cengiz Mordeniz, M.D.
Department of Anesthesiology and Intensive Care
1. Lathrop SL. Animal-caused fatalities in New Mexico, 1993–2004. Wilderness Environ Med
2. Stefanopoulos PK, Tarantzopoulou AD. Facial bite wounds: Management update. Int J Oral Maxillofac Surg
3. Shipkov CD. Nasal amputation due to donkey bite: Immediate and late reconstruction with a forehead flap. Injury Extra
4. Guida G, Nebiolo F, Heffler E, Bergia R, Rolla G. Anaphylaxis after a horse bite. Allergy
5. Vidal S, Barcala L, Tovar JA. Horse bite injury. Eur J Dermatol
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