Advertisement

Negative pressure wound therapy for serious dog bites of extremities: a prospective randomized trial

Published:February 20, 2016DOI:https://doi.org/10.1016/j.ajem.2016.02.043

      Abstract

      Objectives

      The objectives were to investigate the emergency treatment of serious dog bite lacerations on limbs and to identify whether negative pressure wound therapy (NPWT) was beneficial in these instances.

      Methods

      A total of 580 cases with serious limb lacerations due to dog bites were randomly divided into 2 groups. After thorough debridement, the limb lacerations of group A (n = 329) were left open. The remaining cases (n = 251) were randomly divided into 2 subgroups, group B and group C, which were treated with 125 and 75 mm Hg of continuous negative pressure, respectively. Antibiotics were only used in cases where there were systemic signs of wound infection, and were not given prophylactically. The infection rate, infection time, and healing time were analyzed.

      Results

      The wound infection rates of groups A, B, and C were 9.1%, 4.1%, and 3.9%, respectively. The infection times of the 3 groups were 26.3 ± 11.6, 159.8 ± 13.4, and 166.4 ± 16.2 hours, respectively. The recovery times of the infection patients in the 3 groups were 19.2 ± 4.6, 13.2 ± 2.1, and 12.7 ± 2.3 days, respectively, and in the noninfection patients, the recovery times were 15.6 ± 2.7, 10.1 ± 2.3, and 10.5 ± 1.9 days, respectively. In groups B (−125 mm Hg) and C (−75 mm Hg), the infection rate, infection time, and healing time showed no significant differences.

      Conclusion

      Patients with serious dog bite laceration on limbs could benefit from NPWT. Compared with the traditional treatment of leaving the wounds open, NPWT reduced the infection rate and shortened recovery time. When NPWT was performed, low negative pressure (−75 mm Hg) had the same positive effects as high pressure (−125 mm Hg). Prophylactic antibiotics administration is not recommended for treating this kind of laceration.

      Level of evidence

      Therapeutic/care management, level II.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Talan D.A.
        • Citron D.M.
        • Abrahamian F.M.
        • Moran G.J.
        • Goldstein E.J.
        Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group.
        N Engl J Med. 1999; 340: 85-92
        • Anderson P.J.
        • Zafar I.
        • Nizam M.
        • Berry R.B.
        Compartment syndrome in victims of dog bites.
        Injury. 1997; 28: 717
        • World Health Organization
        WHO expert consultation on rabies. Second report.
        World Health Organ Tech Rep Ser. 2013; 982: 1-139
        • World Health Organization
        Rabies vaccines: WHO position paper.
        Wkly Epidemiol Rec. 2010; 85: 309-320
        • Taplitz R.A.
        Managing bite wounds. currently recommended antibiotics for treatment and prophylaxis.
        Postgrad Med. 2004; 116: 49-52
        • Paschos N.K.
        • Makris E.A.
        • Gantsos A.
        • Georgoulis A.D.
        Primary closure versus non-closure of dog bite wounds. A randomised controlled trial.
        Injury. 2014; 45: 237-240
        • Abrahamian F.M.
        Dog bites: bacteriology, management, and prevention.
        Curr Infect Dis Rep. 2000; 2: 446-453
        • Maimaris C.
        • Quinton D.N.
        Dog-bite lacerations: a controlled trial of primary wound closure.
        Arch Emerg Med. 1988; 5: 156-161
        • Medeiros I.
        • Saconato H.
        Antibiotic prophylaxis for mammalian bites.
        Cochrane Database Syst Rev. 2001; N2: CD001738
        • Jofré Morales L.
        • Perret P.C.
        • Abarca V.K.
        • Solari G.V.
        • Olivares C.R.
        • López Del P.J.
        Guidelines for management of animal bites.
        Rev Chil Infectol. 2006; 23: 20-34
        • Chaudhry M.A.
        • Macnamara A.F.
        • Clark S.
        Is the management of dog bite wounds evidence based? A postal survey and review of the literature.
        Eur J Emerg Med. 2004; 11: 313-317
        • Fleisher G.R.
        The management of bite wounds.
        N Engl J Med. 1999; 340: 138-140
        • Capellan O.
        • Hollander J.E.
        Management of lacerations in the emergency department.
        Emerg Med Clin North Am. 2003; 21: 205-231
        • Garbutt F.
        • Jenner R.
        Best evidence topic report. Wound closure in animal bites.
        Emerg Med J. 2004; 21: 589-590
        • Smith M.R.
        • Walker A.
        • Brenchley J.
        Barking up the wrong tree? A survey of dog bite wound management.
        Emerg Med J. 2003; 20: 253-255
        • Chen R.F.
        • Wang L.Q.
        • Li-song H.
        Distribution and characteristics of infection in dog bite wounds.
        China J Emerg Resusc Disaster Med. 2011; 6: 21-23
        • Chen R.F.
        • Wang L.Q.
        The effect analysis of debridement and immunifaction after rabid dog bite.
        Guide China Med. 2012; 5: 401-402
        • Morgan M.
        • Palmer J.
        Dog bites.
        BMJ. 2007; 334: 413-417
        • Dendle C.
        • Looke D.
        Management of mammalian bites.
        Aust Fam Physician. 2009; 38: 868-874
        • Stefanopoulos P.
        • Karabouta Z.
        • Bisbinas I.
        • Georgiannos D.
        • Karabouta I.
        Animal and human bites: evaluation and management.
        Acta Orthop Belg. 2004; 70: 1-10
        • Dean D.J.
        • Baer G.M.
        • Thompson W.R.
        Studies on the local treatment of rabies-infected wounds.
        Bull World Health Organ. 1963; 28: 477-486
        • Armstrong J.A.
        • Froelich E.J.
        Inactivation of viruses by benzalkonium chloride.
        Appl Microbiol. 1964; V12: 132-137
        • Fleischmann W.
        • Strecker W.
        • Bombelli M.
        • Kinzl L.
        Vacuum sealing as treatment of soft tissue damage in open fractures.
        Unfallchirurg. 1993; 96: 488-492
        • Kim P.J.
        • Attinger C.E.
        • Steinberg J.S.
        • Evans K.K.
        • Lehner B.
        • Willy C.
        • et al.
        Negative-pressure wound therapy with instillation: international consensus guidelines.
        Plast Reconstr Surg. 2013; 132: 1569-1579
        • Novak A.
        • Khan W.S.
        • Palmer J.
        The evidence-based principles of negative pressure wound therapy in trauma & orthopedics.
        Open Orthop J. 2014; 8: 168-177
        • Roberts D.J.
        • Jenne C.N.
        • Ball C.G.
        • Tiruta C.
        • Léger C.
        • Xiao Z.
        • et al.
        Efficacy and safety of active negative pressure peritoneal therapy for reducing the systemic inflammatory response after damage control laparotomy (the Intra-peritoneal Vacuum Trial): study protocol for a randomized controlled trial.
        Trials. 2013; 14 ([2013V14N]): 141
        • Peinemann F.
        • Sauerland S.
        Negative-pressure wound therapy: systematic review of randomized controlled trials.
        Dtsch Arztebl Int. 2011; 108: 381-389
        • Masden D.
        • Goldstein J.
        • Endara M.
        • Xu K.
        • Steinberg J.
        • Attinger C.
        Negative pressure wound therapy for at-risk surgical closures in patients with multiple comorbidities: a prospective randomized controlled study.
        Ann Surg. 2012; 255: 1043-1047
        • Kaufman-Rivi D.
        • Hazlett A.C.
        • Hardy M.A.
        • Smith J.M.
        • Seid H.B.
        Provider experiences with negative-pressure wound therapy systems.
        Adv Skin Wound Care. 2013; 26: 311-318
        • Huang C.
        • Leavitt T.
        • Bayer L.R.
        • Orgill D.P.
        Effect of negative pressure wound therapy on wound healing.
        Curr Probl Surg. 2014; 51: 301-331
        • Glass G.E.
        • Murphy G.F.
        • Esmaeili A.
        • Lai L.M.
        • Nanchahal J.
        Systematic review of molecular mechanism of action of negative-pressure wound therapy.
        Br J Surg. 2014; 101: 1627-1636
        • Borgquist O.
        • Ingemansson R.
        • Malmsjö M.
        The influence of low and high pressure levels during negative-pressure wound therapy on wound contraction and fluid evacuation.
        Plast Reconstr Surg. 2011; 127 ([2011V127N2])
        • Kairinos N.
        • Voogd A.M.
        • Botha P.H.
        • Kotze T.
        • Kahn D.
        • Hudson D.A.
        • et al.
        Negative pressure wound therapy. volume II: negative pressure wound therapy and increased perfusion. Just an illusion?.
        Plast Reconstr Surg. 2009; 123: 601-602
        • Lavery L.A.
        • La Fontaine J.
        • Thakral G.
        • Kim P.J.
        • Bhavan K.
        • Davis K.E.
        Randomized clinical trial to compare negative-pressure wound therapy approaches with low and high pressure, silicone-coated dressing, and polyurethane foam dressing.
        Plast Reconstr Surg. 2014; 133: 722-726
        • Garcia V.F.
        Animal bites and pasturella infections.
        Pediatr Rev. 1997; 18: 127-130
        • Goldstein J.C.
        • Citron D.M.
        • Wield B.
        • Blachman U.
        • Sutter V.L.
        • Miller T.A.
        • et al.
        Bacteriology of human and animal bite wounds.
        J Clin Microbiol. 1978; 8: 667-672
        • Medeiros I.
        • Saconato H.
        Antibiotic prophylaxis for mammalian bites.
        Cochrane Database Syst Rev. 2001; 2 (CD001738): 1-14