Best Evidence Topics
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Management of punch wounds to the MCPJ caused by teeth

Three Part Question

In [a young adult with an uncomplicated human bite laceration to MCPJ] is [formal surgical debridement better than wound cleaning in A&E] in [preventing wound infection]?

Clinical Scenario

A 20 year old man presents to the emergency department with a punch injury to his hand and a laceration over the metacarpo-phalangeal joint caused by teeth. X-ray confirms no bony injury, and wound exploration reveals no tendon or joint capsule involvement. There is no obvious sign of infection. You wonder if the patient needs formal surgical debridement or whether wound cleaning in A&E plus antibiotics is adequate treatment.

Search Strategy

Medline 1966-9/99 using OVID interface.
({exp bite, human/ or "human bite".mp. AND exp bites, human/ or exp hand/ or exp hand injuries/ or exp wound infection/ or "hand wound".mp.} AND {exp antibiotics/ or "antibiotics".mp.} AND {exp debridement/ or exp postoperative complications/ or "debride".mp. OR exp irrigation/ or "irrigation".mp. OR exp irrigatio/ or exp wound infection/ or "wound lavage".mp.} LIMIT to human AND English language.

Search Outcome

46 papers of which 39 were irrelevant or of insufficient quality for inclusion. The remaining ones are included in the table below.


No paper actaully answers the question directly, however all studies underline the fact that significant complications occur the longer the wound has been left.

Clinical Bottom Line

In wounds that are uncomplicated, present less than 24 hours in a complient patient, wound debridement in A&E plus antibiotics and daily follow-up is acceptable. All other cases should be admitted for surgical debridement.