What is the management for a 42-year-old man with a 1cm laceration on the palmar surface, sustained from a domestic dog (canis lupus familiaris) bite, without tendon damage?

From the Guidelines

The management of this dog bite laceration should include thorough wound cleaning and evaluation in a medical facility as soon as possible, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.

Key Considerations

• The wound should be thoroughly irrigated until there is no obvious debris or foreign matter in the wound, as recommended by the 2024 guidelines 1.
• The patient should be evaluated in a medical facility as soon as possible due to the risk of infection from animal bites, particularly those caused by dogs.
• Antibiotic prophylaxis may be considered, but the most recent and highest quality study does not provide specific recommendations for antibiotic use in this scenario.

Wound Care

• The wound should be cleaned and irrigated with running tap water or sterile saline solutions, as recommended by the 2024 guidelines 1.
• An occlusive dressing may be used to cover the wound and promote healing, as suggested by the guidelines 1.

Follow-up and Monitoring

• The patient should be instructed to monitor for signs of infection, such as redness, swelling, foul-smelling wound drainage, increased pain, or fever, and to seek medical care if these symptoms develop, as recommended by the 2024 guidelines 1.
• The patient should return for follow-up in 48 hours to assess the wound's healing progress and to evaluate for any signs of infection.

Additional Considerations

• Tetanus prophylaxis should be administered if the patient's immunization is not up to date, and the dog's rabies vaccination status should be verified, with appropriate post-exposure prophylaxis considered if necessary.

From the Research

Wound Management

The management of a 1cm laceration on the palmar surface, sustained from a domestic dog bite, without tendon damage, involves several key steps:

• Irrigation and cleaning of the wound to prevent infection, with no evidence suggesting that antiseptic irrigation is superior to sterile saline or tap water 2
• Occlusion of the wound to prevent contamination 2
• Suturing, if required, can be completed up to 24 hours after the trauma occurs, depending on the wound site 2
• Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years 2

Wound Irrigation

Wound irrigation aims to reduce the microbial burden by removing tissue debris, metabolic waste, and tissue exudate from the surgical field before site closure 3

• Several irrigants are presented, including chlorexidine, povidone-iodine, and hydrogen peroxide, but the effectiveness and safety of these irrigants are still uncertain due to the lack of standardized procedures and high heterogeneity in studies 3
• More randomized controlled studies are needed to provide better quality of evidence regarding the irrigants' effectiveness and safety 3

General Wound Care Principles

Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds, taking into account the cause, chronicity, location, and level of microbial contamination, as well as patient factors that affect wound healing 4

• Knowledge of wound care products available and when negative pressure wound therapy and drain placement is appropriate can improve outcomes with wound healing 4
• Inappropriate product use can cause delays in healing, and the management of a wound and the bandage material used must evolve as the wound healing progresses 4