Animal Bites Treatment & Management

  • Author: Suzanne K Doud Galli, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Sep 23, 2011
 

Medical Care

  • 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.[2]
  • 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

  • Debridement of devitalized tissues in the head and neck region is performed with care.
  • Surgical management can be immediate or delayed.
  • 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.
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Consultations

  • 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, FACS, Consulting Staff, Cosmetic Facial Surgery, Private Practice

Suzanne K Doud Galli, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Rhinologic Society, and Triological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Philip J Miller, MD, FACS  Assistant Professor, Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, New York University School of Medicine

Philip J Miller, MD, FACS 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, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

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, and Pennsylvania Medical Society

Disclosure: Bioform Medical Consulting fee Consulting; Bioform Medical Consulting fee Speaking and teaching

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

Disclosure: Medscape Salary Employment

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

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, 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, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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  12. Oberascher G, Muss N, Gruber W, et al. [Animal bite injuries in the head and neck area and their care]. HNO. Oct 1985;33(10):443-8. [Medline].

  13. Pinckney LE, Kennedy LA. Fractures of the infant skull caused by animal bites. AJR Am J Roentgenol. Jul 1980;135(1):179-80. [Medline].

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  16. Weiss HB, Friedman DI, Coben JH. Incidence of dog bite injuries treated in emergency departments. JAMA. Jan 7 1998;279(1):51-3. [Medline].

 
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