Delayed Human Bite Presenting As Extensive Skin Necrosis Requiring a Posterior Interosseous Artery (PIA) Flap – a Case Report

Introduction: Human bites have been reported as the third most common type of mammalian bites, after dog and cat bites. The polymicrobial nature of human bites can result in severe soft tissue infections. Early debridement, irrigation and antibiotics administration can often limit progression. Few cases outlining severe complications of human bites have been documented in the literature.

Case: We report the case of a 71-year old retired gentleman with a background of Schizophrenia who presented to the Emergency Department with a nine-day old infected human bite to the dorsum of his non-dominant left hand. This resulted from an occlusion bite from the patient’s wife. Extensive skin necrosis and epidermolysis affecting nearly half of the dorsum as well as significant pus collection were observed. Microbiology culture was positive for Streptococcus Anginosus. Aggressive debridement and multiple washouts were performed before a posterior interosseous artery flap was fashioned to reconstruct the resulting defect.

Discussion: Human bites are associated with a higher infection rate than animal bites. Human bites occur most commonly on upper limbs. Hand wounds exhibit a higher rate of infection due to the avascular nature of tendons and joints. The common mistaken assumption of a seemingly innocuous injury often delays presentations, which can result in significant soft tissue damage requiring extensive reconstruction.