Further Outpatient Care
See the list below:
-
Patients who are treated and released are advised to return for consultation in the event of local infection or sepsis.
-
Patients treated with suturing require follow-up for removal of sutures and wound care, and some patients may be monitored on an outpatient basis for local wound care.
Further Inpatient Care
See the list below:
-
For most animal bites, local wound care with thorough cleansing and perhaps suturing of wound edges may be adequate treatment. Not all authors recommend the routine use of antibiotics following these treatments. However, in the event of more extensive injury or the development of infection, hospitalization may be required.
-
With larger animal bites, bedside debridement may not be adequate. In situations with large amounts of tissue loss or an avulsed appendage, surgical debridement of the wound with immediate reconstruction or salvage of an appendage may be required.
Inpatient & Outpatient Medications
See the list below:
-
The routine use of antibiotics for all bite wounds has not been established.
-
Often, persons treated on an outpatient basis are given an oral antibiotic, especially with puncture wounds or wounds that require debridement and suturing.
-
Patients who are admitted and patients who are septic require intravenous antibiotics. Analgesics are prescribed as necessary.
Transfer
See the list below:
-
If an injury is extensive and has resulted in the loss of a significant amount of tissue or an appendage, the patient may be transferred to a tertiary care referral center. There, a patient can be treated with a vascularized free flap or replantation of the appendage.
Deterrence/Prevention
With regard to the prevention of animal bites, the following should be kept in mind:
-
Exposure to animals is clearly a risk
-
The best preventative strategy is to avoid aggressive behavior with animals and avoid unfamiliar animals
-
Teaching young children to avoid unnecessary provocation of animals may lead to fewer incidents of animal bites
-
Not leaving children unattended in the presence of animals may also prevent attacks
A literature review by Duncan-Sutherland et al indicated that the rate of dog bites can be reduced through dog-control legislation, including leash laws and legislation aimed at stray dog control. Breed-specific legislation, however, was found to be less effective. Research also indicated that, by reducing the canine population, sterilization can lead to a decrease in dog bites, but whether this measure impacts dog aggression was not clear. In addition, it was suggested that intensive adult-directed education (but not child-directed education) can lead to a reduction. Moreover, one study found that the dog bite rate significantly declined in association with an alcohol reduction program. [17]
Complications
See the list below:
-
Complications can be considered immediate or delayed.
-
Immediate complications include loss of appendage or disfigurement, which may warrant more extensive reconstruction later. Otherwise, infection is the most common complication of animal bites, which may prompt patients who were previously untreated or self-treated to seek treatment for their injuries.
-
Additional complications associated with infection (eg, sepsis, osteomyelitis, septic arthritis) must be avoided or treated appropriately.
Prognosis
Animal bites lead to few fatalities, and most bites are not treated. Even in complicated cases with extensive tissue loss or infection, the prognosis is generally excellent.
Patient Education
Education is the key to prevention. This is pertinent, especially for children, who are at higher risk for a more serious bite injury. Children can be educated at a young age to avoid strange animals and to avoid aggravating familiar animals.
The small size of children puts them at risk for aggressive, dominating behavior by animals.
-
The child in this photo sustained a dog bite to the face. Courtesy of Wikimedia Commons, Tanner Ford, TRFPhotography.
