Challenging Dogma: Optimal Treatment of the "Fight Bite"

Challenging Dogmas in Plastic Surgery

In medicine, dogmas are subject to evolution and refinement as new research and technologies emerge. The aim of this study was to search for dogmas which were challenged and potentially revised in the plastic surgery field. A search on PubMed for "dogma and plastic surgery" yielded 80 papers. The queries "surgical dogma and craniofacial surgery" and "surgical dogma and flap" returned 9 and 21 papers, respectively. "Surgical dogma and hand" and "surgical dogma and wound healing" produced 41 and 25 papers, respectively. Removing 35 duplicate papers, 141 abstracts were reviewed. Of these, 78 were excluded, leaving 63 papers for analysis. The dogmas being challenged within the field of plastic surgery were classified into various categories. The distribution of these challenged dogmas was as follows: wound healing: 14.29%, epinephrine use: 9.52%, flap surgery: 7.94%, breast reconstruction: 6.35%, rhinoplasty: 7.94%, hand surgery: 4.76%, pressure sores: 4.76%, chemical peel: 4.76%, and hand injuries: 3.17%. The widespread focus on improving wound healing techniques indicates a need for more effective treatments and faster recovery times. Significant attention has been directed toward the use of epinephrine, particularly in fingers, which may reflect ongoing debates about its safety. Innovations and improvements in flap surgery could lead to better reconstructive outcomes. Challenging existing dogma is a vital process and a driving force in the advancement of clinical science. These challenges and potential revisions reflect the dynamic nature of plastic surgery, where ongoing research, patient outcomes, and evolving societal norms drive continuous improvement and adaptation in practices and principles.

All the Better to Taste You With, My Dear: ED Management of Mammalian Bites

Mammal bites account for over 5 million visits to Emergency Departments (EDs) annually. Nurse Practitioners (NPs) need to stay abreast of current guidelines, changes to antibiotic regimens that are now most effective, and understand in what circumstances collaboration with other specialists is indicated. It is not enough to care for the wound, itself, but rather understand in what presentations additional care may be needed despite the fact that there is no clear evidence at the time of evaluation of the need for advanced care. Additionally, NPs should understand what resources are available within their community for wound care that may exceed the scope and ability of the facility in which they practice. Health departments may need to be utilized in the care of ED patients who present with wounds that are suspicious for rabies. Finally understanding what constitutes a high, medium, and low risk bite will aide NPs in delivering optimal care within the communities they serve while also minimizing patient morbidity.

Packing a Punch: Fight Bite Induced Septic Joint

'Fight bites' constitute a considerable number of accidental human bite injuries. Where the mechanism involves a closed fist contacting another person's teeth, the subsequent injury tends to involve the metacarpophalangeal joint region. These injuries are unique for their seemingly benign appearance on initial presentation. Their presence can easily be missed if the treating physician does not seek investigative history and a high index of suspicion. If improperly managed, fight bites may be associated with the introduction of bacteria that may invade deeper tissues, causing potential debilitation from progressive infection. Our case discusses a 33-year-old female who presented three weeks after an altercation where a fight bite occurred but was not treated with antibiotics on discharge. Her clinical presentation matched a flexor sheath infection, which was revealed after investigation to be a consequence of a septic metacarpophalangeal joint that had also progressed to involve the underlying bones. The case outlines the dangers of improper assessment and management of fight bite injuries and reviews best practices surrounding the recognition, assessment, and treatment of these patients in the Emergency Department.