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Watch Out for Wild Animals: A Systematic Review of Upper Extremity Injuries Caused by Uncommon Species

Israel, Jacqueline S. M.D.; McCarthy, James E. M.D.; Rose, Katherine R. M.D.; Rao, Venkat K. M.D., M.B.A.

Plastic and Reconstructive Surgery: November 2017 - Volume 140 - Issue 5 - p 1008-1022
doi: 10.1097/PRS.0000000000003754
Reconstructive: Trunk: Original Article
Press Release

Background: Across the world, many species of nondomesticated animals dwell among humans in metropolitan areas. Rare animal bites pose a dilemma for hand surgeons, as they often result in operative injuries and recalcitrant infections. The authors treated an 85-year-old man who experienced severe cellulitis of the index finger following an opossum bite. This case prompted a systematic review of upper extremity injuries caused by species other than dogs, cats, snakes, and insects.

Methods: The authors conducted a systematic review of PubMed and Scopus databases to identify relevant articles published between 1980 and 2016. Two reviewers critically appraised the studies that met inclusion and exclusion criteria.

Results: The hand infection in the man who sustained an opossum bite at the authors’ institution was successfully treated with targeted antibiotic therapy, hand elevation, and splinting. Seventy-one articles met inclusion criteria for and were included in this systematic review. The vast majority of existing articles represent level IV and level V evidence. The relevant literature suggests that the majority of hand infections attributable to animal bites and stings are polymicrobial.

Conclusions: Injuries secondary to aquatic animals appear to be the most frequently described in the literature, and hot water immersion should be used for the majority of envenomation attributable to aquatic species. Infections can often be treated with an aminopenicillin antibiotic combined with a beta-lactamase inhibitor. Given the variability in presentation and potential for sequelae such as soft-tissue necrosis and systemic reactions, hand surgeons should approach such upper extremity injuries with a high degree of caution.

Madison, Wis.; and Fort Collins, Colo.

From the Division of Plastic Surgery, University of Wisconsin, Madison; and Northern Colorado Plastic and Hand Surgery.

Received for publication February 6, 2017; accepted April 6, 2017.

This review is registered with the National Institute for Health Research PROSPERO International prospective register of systematic reviews under the name “Watch Out for Wild Animals: A Systematic Review of Hand Injuries and Infections Due to Rare Animal Bites,” registration number CRD42016049044 (

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Venkat K. Rao, M.D., M.B.A., Division of Plastic Surgery, University of Wisconsin, Madison, G5/361 Clinical Science Center, 600 Highland Avenue, Madison, Wis. 53792,

Copyright © 2017 by the American Society of Plastic Surgeons