Medical Care
See the list below:
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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.
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In children, primary immediate closure of facial dog bite injuries with antibiotic coverage is suggested. [3]
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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. [16]
Consultations
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Injuries to the head and neck region can be especially complex.
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Involvement of vital structures may require consultation with a head and neck surgeon.
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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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The child in this photo sustained a dog bite to the face. Courtesy of Wikimedia Commons, Tanner Ford, TRFPhotography.
