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

• Published in: The American journal of emergency medicine 2016-06, Vol.34 (6), p.1006-1010
• Main Authors: Rui-feng, Chen, MM, Li-song, Huang, MM, Ji-bo, Zheng, MB, Yi-qing, Jia, MB, Yu-jie, Liu, MM, Yi, Shan, MM
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Animal bites; Animals; Antibiotics; Bites and Stings - therapy; Blood; Clinical trials; Data collection; Debridement; Dogs; Emergency; Emergency medical care; Emergency Service, Hospital; Extremities; Extremities - injuries; Female; High pressure; Hospitals; Humans; Infections; Male; Middle Aged; Negative-Pressure Wound Therapy; Physiology; Polyvinyl alcohol; Prospective Studies; Studies; Surgery; Wound Healing; Young Adult
• ISSN: 0735-6757; 1532-8171
• DOI: 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.