Dog bites can be physically and emotionally devastating injuries especially if the victims are children. In the US the dog most commonly responsible is the Pit bull in about 50% of cases. Rottweilers account for about 10% of dog bites. Mixed breeds containing one of the two aforementioned breeds make up about 5% of the rest. The summer months are the most common times for dog bites.
The management of dog bites is complex and varies based on the severity of injury. Initial work up should include a high level of suspicion for deeper injuries to important nerves, tendons, blood vessels and bones of the hand. Bone fractures should be ruled out with hand X-Rays. MRI and CT scan are also advisable of suspicion of deep tissue infections.
Because certain dogs have very powerful jaw strength and sharp long teeth there should always be a high level of suspicion that the level of traumatic injury to the hand, wrist and forearm can be deeper than what is seems.
Simple scratches or deep puncture wounds should be irrigated well in the emergency room and washed out and allowed to heal by secondary intention. Secondary intention means that the wound is allowed to heal by itself with proper and guided wound care management.
Deeper wounds that are simple may also be managed in the emergency room. They require copious irrigation and wash out, debridement of any foreign debris and desiccated tissue and then surgical closure.
More complex dog bite wounds, or dog bite wounds on the face and neck, or dog bites in children will need to be treated in the operating room under general anesthesia.
In the operating dog bites must be irrigated well with copious solution of normal saline and antibiotics, undergo wound debridement and removal of all foreign debris. If the wound injury is extensive it may be advisable to wait for 48 hours to allow the healthy wound tissue to demarcate. This will allow the surgeon to perform a more conservative wound and tissue debridement and maintain more viable tissue for reconstruction.
If significant tissue is lost then additional reconstructions may be required with the use of skin grafts or local flaps for reconstruction.
Dog bites management must address the whole patient systemically. If the patient has not had a tetanus immunization within the last 5 years, then tetanus immunization (diphtheria/tetanus toxin) and tetanus immune globulin are recommended at the time of the dog bite.
If the immunization history of the dog is not known then rabies prophylaxis is also indicated at the time of the dog bite. Rabies immune globulin (RIG) is recommended to be administered to the patient.
I am a proponent of early use of antibiotics on dog bites. Pasteurella Multocida and Staphylococcus Aureus are the most common bacteria causing infection in dog bites. I recommend (Amoxil) Amoxicillin/clavulanate. In the ER or OR the patient can receive (Unasyn) Ampicillin/sulbactam. If a patient ahs allergy to penicillin then I recommend Doxycycline or erythromycin. Doxycycline should not be given to women who may be pregnant. Additionally I recommend (Bactrim) Sulfamethoxazole/trimethoprim either alone or in combination.