Dog bite injuries to the hand.

Dog bites to the hand and forearm are common. Although bites are usually minor, aggressive dogs may cause extensive bites developing to a public health problem. In a database review of dog bites to the hand applied to Emergency Department or to the Department of Hand Surgery in Malmö, Sweden 2008-2009, we found 81 cases [42 men and 39 women; median age 45 (range 2-88) years]. Three of 81 (4%) were children younger than 11 years. Six of the 81 (8%) patients included had bilateral injuries. Seventy-five patients were treated at the Department of Hand Surgery, where 31 of 75 (41%) were admitted to hospital in 181 days (median 4, range 1-20). The injuries included lacerations of the skin, muscle, and tendons as well as fractures, arterial and nerve injuries, and traumatic amputations of fingers. Some cases developed infections, necrosis of muscle and skin, arthritis, osteomyelitis, and even sepsis. A total of 96 operations were done for 51 patients (median 1, range 1-8) and the patients had 343 (median 2, range 0-22) outpatient visits. Almost half of the bites occurred when the patients was trying to separate two fighting dogs. The size of the lacerations increased with the size of the dog. Serious infections were found independently of size of dog. We suggest that education of owners and the public, reporting of all bites, and control of animals are some of the actions to reduce the number of attacks. At least one serious case could have been prevented if the dog had been put down after a previous serious attack.