From the Guidelines
Dog bites should generally not be sutured immediately due to the high risk of infection. Instead, these wounds should be thoroughly cleaned with soap and water, irrigated with sterile saline, and left open to heal by secondary intention. This approach is supported by the most recent and highest quality study, which emphasizes the importance of wound cleansing and the risks associated with primary closure 1.
Key Considerations
- Exceptions where suturing may be considered include facial wounds (for cosmetic reasons) or large wounds that cannot be managed with dressing alone, but even these should be approached cautiously.
- If suturing is deemed necessary, it should be done after proper wound cleaning and within 8 hours of injury, often with delayed primary closure after 3-5 days of observation.
- All dog bite victims should receive appropriate antibiotics such as amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-7 days to prevent infection, as recommended by guidelines for the management of skin and soft tissue infections 1.
- Tetanus prophylaxis should be updated if needed, and rabies risk should be assessed, considering the guidelines for human rabies prevention 1.
Rationale
The concern with immediate closure is that dog bites introduce bacteria deep into tissues, creating an ideal environment for infection when the wound is sealed. Allowing the wound to remain open initially permits drainage and better healing outcomes in most cases. While there are exceptions and considerations for specific types of wounds, the general principle of avoiding immediate suturing unless absolutely necessary is supported by the evidence 1.
Management Approach
- Thorough wound cleaning and irrigation
- Antibiotic prophylaxis with amoxicillin-clavulanate
- Tetanus prophylaxis update if necessary
- Rabies risk assessment
- Consideration for delayed primary closure in select cases, with careful monitoring for signs of infection.
From the Research
Dog Bite Suturing
- Dog bites can cause significant injury and are a major health concern, with an average of 337,000 emergency visits and $2 billion in medical costs per year in the United States 2.
- The decision to suture a dog bite wound depends on various factors, including the risk of infection, wound location, and cosmetic considerations.
Factors Influencing Suturing Decision
- Wound location: Wounds on the face or head and neck area may be sutured for cosmetic reasons, while wounds on the extremities or hands may not be sutured due to higher risk of infection 3, 4.
- Risk of infection: Wounds with a high risk of infection, such as puncture wounds or wounds in immunosuppressed individuals, may not be sutured 3.
- Time of management: Early treatment, within 8 hours of injury, may result in lower infection rates and improved cosmetic appearance, regardless of suturing or not 4.
Suturing Outcomes
- A randomized controlled trial found that primary suturing of dog bite wounds resulted in similar infection rates compared to non-suturing, but improved cosmetic appearance 4.
- Another study found that wounds treated with primary closure had a lower infection rate (0.53%) compared to those left open, but this difference was not statistically significant 5.
Management Recommendations
- Dog bite wounds should be examined, cleaned, and irrigated with warm water or normal saline solution, and any foreign bodies and devitalized tissue should be removed 2.
- Antibiotic prophylaxis, with amoxicillin/clavulanate as the first-line choice, should be considered for all bites, particularly for those at increased risk of infection 2, 3.
- The need for tetanus vaccination and rabies postexposure prophylaxis should be evaluated for each patient 2, 3.