When I evaluate a bite wound, I first search for and address limb- or life-threatening injuries. I establish the severity of the injury by determining the depth of the wound and involvement of underlying soft tissue, muscle, or bone. I ensure proper blood flow to and neurologic function of the injured area. As I thoroughly examine the wound, I consider the need for wound irrigation, primary closure, antimicrobial prophylaxis, and proper pain control. Among the key priorities for animal bite wound care is the restoration of normal function and prevention of infection. Animal bites that penetrate the skin are considered dirty wounds. Wounds in highly vascular areas such as the face and scalp are at lower risk of bacterial infection.¹ Primary closure of a wound is associated with higher infection rates, although carefully selected wounds can be repaired with little risk of infection.^2,3 Thorough irrigation with a high volume of saline delivered under high pressure is the most effective means of cleaning the wound and minimizing the risk for infection,⁴ and I therefore irrigate all bite wounds meticulously. I choose prophylactic antibiotics to cover the expected bacteria in the mouth of the biting animal. Animal wounds that become infected contain predictable pathogens.^5,6 A 3- to 5-day course of prophylactic antibiotics is recommended for wounds considered to be at high risk for infection.⁷ Amoxicillin-clavulanate is the most commonly chosen antibiotic for animal bite prophylaxis.^7,8 These recommendations are based on consensus opinion, because there are no definitive studies that demonstrate a reduction in infection rate as the result of prophylactic antibiotics.⁹

→ Medical imaging may be necessary, depending on the potential for injury to underlying structures.

→ Computed tomography (CT) scan of the head: If there is penetrating injury of the scalp and there is concern for skull fracture or intracranial air. $750

→ Plain radiographs: If there is a concern for underlying fractures. $75