Human Bites A Penetrating Man-to-Man Trauma

DUBLIN, June 21 -- When alcohol turns fighting into biting, it's a problem for the emergency department

Although less ballyhooed than the infamous Mike Tyson ear-gnawing boxing incident, man-bites-man wounds are common on holiday weekends in the emergency unit, according to Patricia Eadie, MBBCh., and colleagues of St James's Hospital here.

The "fight bite" -- when a closed fist meets a tooth -- is relatively well understood, but the occlusive bite, in which the teeth close through the flesh, is less well documented, reported Dr. Eadie and colleagues in the July issue of the Emergency Medicine Journal.

"I think a lot of people wouldn't know this happens, or to the extent that it happens," Dr. Eadie said.

The researchers looked at all the occlusive bite cases that showed up at their department from January 2003 through December 2005.

All told, they had 92 cases and analysis revealed a pattern of alcohol-fueled aggression by young men on weekends and holidays. Specifically:

• The 92 patients had 96 bites.
• 85 of them were men, with a median age of 22, although they ranged as young as 16 and as old as 57.
• Alcohol was involved in 86% of the incidents and recreational drugs in 12%.
• The median time of the incidents was three in the morning, with 82% of all injuries occurring between 11p.m. and 4 a.m.
• 70% of the injuries occurred on weekends and public holidays.

The face and upper limbs were the primary targets, Dr. Eadie and colleagues found. The face accounted for 81 wounds (84%), and 66% involved the ear, although the nose, chin, cheek, forehead, and lips were also targets. The remaining 15 wounds were to the upper limb, mainly the hands.

While upper limb bites were a small proportion of the total, they accounted for 39% of the cases of infection, the researchers found, possibly because the increased vascularization of the face leads to more bleeding and thus a lowered chance of contamination.

Treatment for such wounds is standard, the researchers said -- adequate irrigation, debridement and direct closure where possible. Closure shouldn't be delayed unless the wound has been inadequately cleaned or is visibly contaminated or infected. Prophylactic antibiotics should be used, the authors said.

Finally, patients should be referred to a specialist center for complex hand injuries or "injuries to aesthetically significant areas," they said.

Interestingly, however, Dr. Eadie and colleagues found that only 14% of the patients referred to their cosmetic surgery department either had or planned to have reconstructive surgery.