Dog Bite to right hand
History:
A 55 year old mechanic who sustained a dog bite to his right hand. He is right-handed, a non-smoker and has had prior carpal tunnel surgery on the right hand. He works with his hands every day and would like to regain function of his hand as soon as possible. He reported moderate bleeding from his right hand that was controlled with pressure. TDAP vaccine and IV Unasyn antibiotic were given in the ED. The dog was up-to-date with his vaccines. The Plastics and Reconstructive Surgery team was consulted for the hand laceration.
Findings:
Right hand with soft tissue avulsion injury to the radial aspect of dorsum with exposed soft tissue. Significant swelling to dorsum. No other injuries.
Figure 1. Shows right hand soft tissue avulsion injury from dog bite.
Diagnosis:
Right hand dog bite with skin avulsion. No tendon or ligament injuries. R/O bone or neuro-vascular injuries.
Differential Diagnoses:
Workup Required:
X-rays of the right hand to evaluate for fractures and possible retained foreign bodies.
Plan:
Copious irrigation and repair of the laceration under local anesthesia in the Emergency Department.
Expertise Needed:
Plastic surgeon or Hand surgeon.
Treatment:
Local anesthesia with 1% plain lidocaine provided a local block. The hand was prepped with betadine and draped using sterile towels. The wound was copiously irrigated with normal saline and betadine. Figure 1 shows the right hand soft tissue avulsion injury. Given the dog bite had just occurred, no fracture or exposure of vital structures, timely administration of IV antibiotics and adequate wound washout, we felt comfortable proceeding with wound closure. The laceration was repaired with 4-0 Chromic sutures and soft dressings were applied.
Figure 2. Shows repaired laceration.
Follow Up:
Arm elevation was encouraged to minimize pain and swelling . Tylenol and ibuprofen were used to control pain. He was told to return in one week. When the patient was seen for his 1 month follow up. There was no pain to the right hand and the wound was healed. He had full range of motion and was able to use the hand without limitations.
Figure 3-5. One month follow up.
