[Flawed initial treatment of dog bite injury]

A 73-year-old male patient suffered multiple dog bites to the left hand and lower arm. The initial treatment in hospital consisted of conservative treatment with wound closure strips and bandages. For further treatment the patient was referred to the general practitioner who found a discharge of pus below the wound closure strips 2 days later. On the 3rd day the patient was admitted to a different hospital where surgical treatment with débridement, placement of vacuum bandages and subsequent flap plasty was conducted on admission. An examination 1 year later revealed stabbing pain over the carpometacarpal joint radiating into the thumb, hypoesthesia of the back of the hand, numbness of the thumb on the ulnar side, reduced range of movement in the wrist and thumb and suspected development of a neuroma. In the subsequent arbitration procedure, the patient criticized the initial treatment and claimed that the bite wounds were not cleansed and were then closed with wound closure strips without antibiotic treatment. This was assumed to have caused extensive infection, which required surgical treatment and caused lasting complaints. The arbitration board report determined an insufficient initial clinical assessment and a faulty wound care resulting in, among other things, reduced range of movement of all fingers of the left hand.