DOI: http://dx.doi.org/10.18203/2349-2902.isj20183452

Diverse spectrum of facial dog bite presentation and their management

Rakesh Kumar Jain, Gautam Prakash, Manojit Midya, Pankaj Sharma

Abstract


Background: Dog bite patients are frequently encountered in our hospital seeking immediate as well as delayed reconstruction. More than two third of dog bite injuries involve head, neck and scalp region. Facial dog bites present a challenge for the surgeon, as they lead to cosmetic disfigurement and psychological trauma to the patient. Following thorough washout and debridement, we have used various reconstructive techniques for definitive management of wounds like- primary repair, V-Y advancement flap, nasolabial flap, SSG, FTG and Karapandzic flap. Purpose of the present study is to share our experiences in management of dog bite wounds on the face in both adult and paediatric patients with available reconstructive options to maximize the functional and cosmetic outcomes by using basic principles of surgery.

Methods: Present study was a single centre retrospective study conducted in a tertiary care centre from February 2013 to January 2018. Total 497 patients of dog bite who presented in the emergency department were enrolled. Out of them 310 patients had involvement of head, neck and scalp requiring surgical intervention in any form.

Results: In last five years, we have encountered mid face predilection in face, head and neck cases. Out of 310 cases, lip (25.16%) and cheek (24.51%) were involved in majority of the patients. Flap cover surgery is required in majority of the scalp and nose group of patients, as there is less mobility of tissue present in surrounding region, while cheek and lip were managed with primary closure in most of the patients.

Conclusions: Although most of the dog bites are preventable, but cases of dog bite are increasing continuously. Child should never be left alone with dogs and, if they are fear of dogs, it’s better not to obtain dogs. As far now, it’s a major concern for treating physician or surgeon to provide optimal cosmetic as well as functional outcome. Early surgical intervention for wound management gives better results with the use of basic principles of plastic surgery.


Keywords


Dog bite, Dog bite management, Facial injury

Full Text:

PDF

References


Davis SJM, Valla R Francois. Evidence for domestication of the dog 12,000 years ago in the Natufian of Israel. Nature. 1978;276:608-10.

Mcheik JN, Vergnes P, Bondonny JM. Treatment of facial dog bite injuries in children: a retrospective study. J Pediatr Surg. 2000;35:580-3.

Calkins C, Bensard D, Patrick D, Karrer F. Life threatening dog attacks: a devastating combination of penetrating and blunt injuries. J Pediatr Surg. 2001;36:1115-7.

Galloway RE. Mammalian bites. J Emerg Med. 1988;6:325-31.

Baker MD, Lanuti M. The management and outcome of lacerations in urban children. Ann Emerg Med. 1990;19:1001-5.

Alizadeh K, Shayesteh A, Xu L Min. An algorithmic approach to operative management of complex pediatric dog bites: 3-year review of level I regional referral pediatric trauma hospital. Plast Reconstr Surg Glob Open. 2017;5:1431.

Chaudhuri S. Rabies prevention and dog population management. india’s official dog control policy in context of WHO guidelines. Ecollage. 2005.

Goldstein EJ. Current concepts on animal bites: bacteriology and therapy. Curr Clin Top Infect Dis. 1999;19:99-111.

Borud LJ, Friedman DW. Dog bites in New York City. Plast Reconstr Surg. 2000;106:987-90.

Mitchell RB, Nanez G, Wagner JD, Kelly J. Dog bites of the scalp, face and neck in children. Laryngoscope. 2003;113:492-5.

Savino F, Gallo E, Serraino P, Oggero R, Silvestro L, Mussa GC. Dog bites in children less than fourteen years old in Turin. Minerva Pediatricia. 2002;54:237-42.

Akhtar N, Smith MJ, McKirdy S, Page RE. Surgical delay in the management of dog bite injuries in children, does it increases the risk of infection? J Plast Reconstr Aesthetic Surg. 2006;59:80-85.

Palmer J, Rees M. Dog bites of the face: a 15-year review. Br J Plast Surg. 1983;36:315-8.

Kaye AE, Belz JM, Kirschner RE. Pediatric dog bite injuries: a 5-year review of the experience at the Children’s Hospital of Philadelphia. Plast Reconstr Surg. 2009;124:551-8.

Weiss HB, Friedman D, Coben JH. Incidence of dog bite injuries treated in emergency departments. JAMA. 1998;279:51-3.

Bernardo LM, Gardner MJ, Rosenfield RL, Cohen B, Pitetti R. A comparison of dog bite injuries in younger and older children treated in a pediatric emergency department. Pediatr Emerg Care. 2002;18:247-49.

Gershman KA, Sacks JJ, Wright JC. Which dog bites? A case control study of risk factors. Pediatr. 1994;93:913-7.

Lackmann G, Wolfgang D, Isselstein G, Tollner U. Surgical treatment of facial dog bites injuries in children. Craniomaxillofac Surg. 1992;20:81-6.

Jone RC, Shires GT. Bites and stings of animals and insects. Principles of surgery. New York: McGraw-Hill; 1979.

Barry EL. Facial dog bite injuries in children: treatment and outcome assessment. J Craniofac Surg. 2013;24:384-6.