Disastrous Progression

Surgical treatment, which is of central importance, was explained to an unsatisfactory degree (1). One should urgently advise against wound irrigation using button cannulas or infusion catheters (2). If a bite wound is such that this idea arises then this is merely an indication for “real” surgical debridement in the operating room and under general anesthesia. Half-hearted and inconsistent primary treatments often result in disastrous disease progression. The indication for primary surgical debridement should be defined generously. In my own practice it has proved successful to operate on any bite wound as a matter of principle and to permit exceptions when there are good reasons for doing so. Every patient with a bite wound on their hand should immediately be referred to a center for hand surgery; for facial bite wounds, institutions for plastic surgery are available. Necrosectomy is never limited by the anatomical situation but is mandatory in every case. Necroses have to be removed, even from the face (3).

It goes without saying that the necrosectomy should be done subtly, with the help of magnifying spectacles, in order to spare healthy tissue. Correct necrosectomy is the basis for the best possible healing result without too much scarring (4). The authors are correct to point out that patients and physicians often underestimate the seriousness of smaller injuries; this is especially the case for bite wounds to the hands. The unspeakable “faffing about” with loop drains threaded through infected tissue, preferably on the hand, is unfortunately still a common phenomenon.