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These multiple facial lacerations required debridement and plastic surgical reconstruction. The removal of crushed devitalized tissue in an attempt to make the first repair count. A good reconstruction at the time of injury may prevent the need for subsequent revision. Early plastic surgery can sometimes prevent the need for later plastic surgery. Some insurance companies no longer pay for revision of scars claiming such reconstruction is "cosmetic" and not covered under the policy.Surgery done by Dr.Michael Bermant, MD, Board Certified by the American Board of Plastic Surgery.
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Will A Dog Bite Your Child?
Every year 4.5 million people are bitten by dogs in the United States. Bites to children represent more than 50 % of these cases. The majority of victims are boys of whom 62% are less than 6 years old. About 26 % of dog bites in children require medical care. In extreme situations, about 18 people die from dog bites every year.
HOW BIG OF A PROBLEM ARE DOG BITES?
Approximately 35 percent of American households own a dog.
Dog bites account for approximately 1% of emergency room visits in the United States.
There are approximately 914 dog bites injuries requiring emergency department treatment in the United States every day.
The national annual payment to emergency departments for care of dog bite injuries is around $102 million.
WHICH DOGS BITE CHILDREN?
Any dog that perceives itself to be threatened is capable of biting.
Most biting dogs are medium and large breeds.
Male dogs are more likely to bite than female dogs.
Un-neutered dogs appear more likely to bite than neutered ones.
In most cases, the attacking dog belongs to the child’s family, or a neighbor, and is known to the victim.
From 1979 to 1988, pit bulls caused more than 41% of dog-bite fatalities.
WHY DO DOGS BITE CHILDREN?
The family dog has retained many of its wild instincts, including behaviors that lead to biting children.
Dogs bite children because of: inadequate socialization, territoriality, fear, jealousy, dominance behavior, or overbreeding.
Dominance aggression and biting happens to children known to the dog, and in the dog’s familiar surroundings.
Young children often bring their face into the dog’s intimate space, creating a threat to the dog.
Dogs bite children in the face and neck, in part, because that’s how dogs learn dominance behavior with each other.
WHERE DO DOG BITES TAKE PLACE?
Dogs usually bite familiar children near their homes.
In cases involving child death, 59% involved an unrestrained dog on the owner’s property, and 10% involved a sleeping infant.
Aggressive biting behavior near the dog’s home may be related to the dog’s territorial behavior.
WHAT IS THE NATURE OF A DOG BITE INJURY?
Young children are prone to severe dog bites involving the head, face, and neck.
Children are small, and their head and neck are very close to an attacking dog.
The nose, mouth, and parotid gland areas are the primary targets for dog bites.
The better the blood supply to the wound, and the easier it is to clean the wound the lower the risk of infection.
Bites to the hand have a high risk for infection because of its relatively poor blood supply.
Most deaths in children occur due to hemorrhage from the great blood vessels of the neck.
FIRST AID FOR A DOG BITE:
Wash the wound area with water and liquid soap for 10 minutes before going to the doctor’s office.
Check your child’s shot record to see when the last tetanus shot was given. If your child has not had a tetanus booster within 5 years, another one will need to be administered within 3 days.
If there is any possibility of rabies, the dog should be carefully observed for 10 days for any signs of sickness.
MEDICAL TREATMENT FOR A DOG BITE:
The dog bite injury should be documented with photographs and diagrams, if necessary.
Proper medical treatment for dog bites requires an understanding of the canine oral bacteria which cause infections.
The most common aerobic bacteria in bite wounds are: Pasturella, alpha-hemolytic Streptococci, and Staphylococcus aureus – occurring in 20 to 30 percent of infected dog bite wounds.
The most common anaerobic organisms are Bacteroides and Fusobacterium – which are found in up to 41% of dog bite wounds.
X-rays may be necessary to determine underlying bone or joint injury, because dogs can exert a tremendous force when biting.
Animal bites should be separated into high risk and low risk groups when deciding on whether to suture the wounds or provide or provide antibiotic coverage.
Proper bite wound care includes: inspection, debridement, irrigation, and if indicated – closure. High-risk wounds generally require antibiotics.
The bite wound should be cleansed carefully and irrigated with normal saline under pressure using a 19-gauge blunt needle, and a large syringe.
Bacterial cultures obtained at the time of injury are not useful, because they do not predict infections.
High-risk wounds include: wounds of the hand or foot; deep puncture wounds; surgically debrided wounds; wounds involving the joints, ligaments, tendons, and bones; dog bites where treatment has been delayed more than 12 hours; and bites in immunocompromised patients.
High-risk wounds should not be sutured, but should receive antibiotic treatment. In that case, a beta-lactam antibiotic, such as Augmentin, should be prescribed for at least 10 days.
Low-risk wounds include bites to the face and body.
After a thorough search for damaged salivary ducts, facial nerve, and blood vessels – many facial wounds can be sutured.
Low-risk wounds may be sutured, especially in the face, and do not necessarily require antibiotic treatment, unless infected.
Appropriate tetanus and rabies prophylaxis should be provided based on the child’s medical history.
COMPLICATIONS
In children, dog bites frequently involve the face, potentially resulting in severe lacerations and scarring.
Wound infection: occurs in 2-30% of dog bites and 15-50% of cat bites. Risk of infection is particularly high in: puncture wounds; hand injuries; full-thickness wounds; wounds requiring surgical debridement; and wounds involving joints, tendons, ligaments, or fractures.
Less frequent complications include tetanus, rabies, septicaemia, septic arthritis, tenosynovitis, tendonitis, fractures, osteomyelitis, peritonitis, endocarditis, endophthalmitis, meningitis, and disfiguring wounds from severe mauling7.
Cat-scratch disease is caused by Bartonella henselae and can follow a bite or scratch from a cat or dog.
Capnocytophaga canimorsus (part of the normal canine oral flora) has been associated with severe infections in immunocompromised patients, which may result in meningitis, endocarditis, renal failure, and septicaemia. Complications courtesy of Patient Plus.
HOW CAN DOG BITES BE PREVENTED?
Children should always be supervised when they are around any dog.
Teach children not to pet a dog without first letting the dog sniff them.
Direct eye contact should be avoided, since a dog may interpret that as aggression.
Teach children not to run and scream in the presence of a dog, since dogs tend to chase a moving object.
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