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Animal Bites Treatment & Management

  • Author: Suzanne K Doud Galli, MD, PhD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: May 19, 2016
 

Medical Care

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  • Thorough cleansing is adequate for contused, intact skin. If the skin is penetrated, copious irrigation is warranted. Debridement is then required to remove any devitalized tissues resulting from the crush injury of the bite.
  • In children, primary immediate closure with antibiotic coverage is suggested.[8]
  • Special consideration is given to injuries to the head and neck region because of their close proximity of vital structures and the importance of cosmesis in this region. Consultation with a specialist may be required.
  • Basic wound management is the sine qua non of therapy for animal bites. Treatment may include debridement, antibiotic therapy, supportive care, and, possibly, primary suturing or hospitalization with operative debridement. Of all bite injuries, 1-3% require hospitalization for surgical debridement and intravenous antibiotics. Clearly, wound severity dictates surgical management.
  • Tetanus toxoid is administered, and the rabies status of the animal is investigated. In the event of possible rabies exposure, human diploid vaccine can be administered.
  • Wounds can be classified as abrasions, lacerations, punctures, and avulsions. In the head and neck region, avulsions of special appendages are of particular concern, with the lip being the most common site of injury.
  • The bite of a dog can yield between 150-450 pounds of pressure per square inch, depending on the dog and its training. Therefore, although a dog bite may appear as a laceration or avulsion, it most likely has components of a crush injury. Therefore, in this type of injury, debridement is required to remove any crushed tissues. Once débrided, the laceration injury is then amenable to suturing and primary closure.
  • The force of a domestic cat's bite does not match that of a dog. However, its sharp teeth may cause a puncture wound into which bacterial organisms are inoculated. The risk of infection is compounded by the feline habit of paw licking, which may contaminate their claws with oral flora. The risk of infection is higher following a cat bite than a dog bite. Also, cat bites carry the risk of causing catscratch fever with resultant adenopathy. However, this is usually self-limited.
  • Signs of infections are typical and include rubor, dolor, calor, and edema of the tissues. Purulent discharge from the wound is another good indicator of infection. Signs of infections may appear 24-72 hours following the bite. Obtain wound cultures to guide antibiotic therapy. Blood cultures are necessary if signs of a systemic infection are present. Drain any collections.
  • Initial wound care mandates vigorous cleansing. This is accomplished easily with copious saline lavage under pressure. Puncture wounds also require copious lavage. Irrigation with povidone-iodine solution (Betadine) also may have an antiseptic effect.
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Surgical Care

Laceration injuries can be closed primarily, but avulsion injuries may benefit from delayed treatment. Injuries with significant tissue loss may require local flap treatment, composite grafts, or even vascularized flaps. Debridement of devitalized tissues in the head and neck region must be performed with care.

A study by Gurunluoglu et al indicated that the optimal treatment of facial dog bites requires that level-I trauma centers have a plastic surgery service available. In a study of 75 patients whose facial dog bite injuries who were treated only by a plastic surgery service (with 60 of 98 total wounds being treated by direct repair), the investigators reported that good outcomes were achieved by direct repair and reconstruction of these injuries as early as possible, with a low complication rate and a high rate of patient satisfaction achieved.[9]

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Consultations

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  • Injuries to the head and neck region can be especially complex.
  • Involvement of vital structures may require consultation with a head and neck surgeon.
  • Because of cosmesis issues, consultation with a facial plastic surgeon may be required to ensure proper closure of a complex bite, to a repair fracture, or for reconstruction.
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Contributor Information and Disclosures
Author

Suzanne K Doud Galli, MD, PhD Consulting Staff, Cosmetic Facial Surgery, Private Practice

Suzanne K Doud Galli, MD, PhD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Philip J Miller, MD 

Philip J Miller, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American College of Surgeons, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Dominique Dorion, MD, MSc, FRCSC, FACS Deputy Dean and Associate Dean of Resources, Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Université de Sherbrooke, Canada

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Clark A Rosen, MD Director, University of Pittsburgh Voice Center; Professor, Department of Otolaryngology and Communication Science and Disorders, University of Pittsburgh School of Medicine

Clark A Rosen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Pennsylvania Medical Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Merz North America Inc<br/>Received consulting fee from Merz North America Inc for consulting; Received consulting fee from Merz North America Inc for speaking and teaching.

References
  1. Garvey EM, Twitchell DK, Ragar R, et al. Morbidity of pediatric dog bites: a case series at a level one pediatric trauma center. J Pediatr Surg. 2015 Feb. 50(2):343-6. [Medline].

  2. Pfortmueller CA, Efeoglou A, Furrer H, et al. Dog bite injuries: primary and secondary emergency department presentations--a retrospective cohort study. ScientificWorldJournal. 2013. 2013:393176. [Medline]. [Full Text].

  3. Tabaka ME, Quinn JV, Kohn MA, et al. Predictors of infection from dog bite wounds: which patients may benefit from prophylactic antibiotics?. Emerg Med J. 2015 Jan 29. [Medline].

  4. Babovic N, Cayci C, Carlsen BT. Cat bite infections of the hand: assessment of morbidity and predictors of severe infection. J Hand Surg Am. 2014 Feb. 39(2):286-90. [Medline].

  5. Chu AY, Ripple MG, Allan CH, et al. Fatal dog maulings associated with infant swings. J Forensic Sci. 2006 Mar. 51(2):403-6. [Medline].

  6. Toure G, Angoulangouli G, Méningaud JP. Epidemiology and classification of dog bite injuries to the face: A prospective study of 108 patients. J Plast Reconstr Aesthet Surg. 2015 May. 68 (5):654-8. [Medline].

  7. Rezac P, Rezac K, Slama P. Human behavior preceding dog bites to the face. Vet J. 2015 Dec. 206 (3):284-8. [Medline].

  8. Wu PS, Beres A, Tashjian DB, Moriarty KP. Primary repair of facial dog bite injuries in children. Pediatr Emerg Care. 2011 Sep. 27(9):801-3. [Medline].

  9. Gurunluoglu R, Glasgow M, Arton J, et al. Retrospective analysis of facial dog bite injuries at a Level I trauma center in the Denver metro area. J Trauma Acute Care Surg. 2014 May. 76(5):1294-300. [Medline].

  10. Massari M, Masini L. Relationships among injuries treated in an emergency department that are caused by different kinds of animals: epidemiological features. Eur J Emerg Med. 2006 Jun. 13(3):160-4. [Medline].

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Animal bites. The devastating damage sustained by a preadolescent male during a dog attack. Almost lost in this photograph is the soft tissue damage to this victim's thigh. This patient required 2 units of O- blood and several liters of isotonic crystalloid. Repair of these wounds required a pediatric surgeon, an experienced orthopedic surgeon, and a plastic surgeon. Attacks such as these have caused a movement in some areas of the country to ban certain dog breeds.
 
 
 
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