Should a dog bite wound be closed immediately?

Management of Dog Bite Wounds: Primary Closure vs. Leaving Open

Primary wound closure is not recommended for dog bite wounds except for those to the face, which should be managed with copious irrigation, cautious debridement, and preemptive antibiotics. 1

Wound Closure Recommendations Based on Location

Face Wounds

• Face wounds are an exception and can be closed primarily if:
  • Thorough wound cleansing with sterile normal saline is performed
  • Copious irrigation is completed
  • Cautious debridement of superficial debris is done
  • Preemptive antibiotics are administered 1, 2
  • The wound is seen and managed early (ideally within 8 hours of injury) 1

Non-Facial Wounds

• Primary closure is generally not recommended for:

  • Hand wounds (higher infection risk than other locations) 1, 3
  • Puncture wounds (should not be closed) 1
  • Heavily contaminated wounds 4
  • Wounds presenting >24 hours after injury

• For non-facial wounds, consider:

  • Wound approximation with Steri-Strips rather than sutures 1
  • Delayed primary or secondary closure 1

Comprehensive Management Algorithm

1. Initial Assessment

   • Evaluate wound severity, location, and time since injury
   • Assess for signs of infection or involvement of deeper structures (bone, joint, tendon)

2. Wound Preparation (All Wounds)

   • Immediate and thorough washing with sterile normal saline 1
   • Remove superficial debris
   • Avoid deep debridement unless absolutely necessary 1
   • Do not use iodine or antibiotic-containing solutions 1

3. Decision on Closure

   • For facial wounds: Primary closure with sutures if seen early and after thorough cleaning 1, 2, 5
   • For hand wounds: Leave open due to higher infection risk 1, 3
   • For other body locations: Consider approximation with Steri-Strips rather than sutures 1

4. Antibiotic Prophylaxis

   • Preemptive antimicrobial therapy (3-5 days) for:

     • Facial wounds that are closed 1
     • Immunocompromised patients
     • Asplenic patients
     • Patients with advanced liver disease
     • Wounds with preexisting or resultant edema
     • Moderate to severe injuries
     • Injuries that may have penetrated periosteum or joint capsule 1

   • Preferred antibiotic: Amoxicillin-clavulanate (covers both aerobic and anaerobic bacteria) 1

5. Tetanus Prophylaxis

   • Administer tetanus toxoid to patients without vaccination within 10 years
   • For dirty wounds, give booster if >5 years since last dose
   • For clean wounds, give booster if >10 years since last dose
   • Tetanus, diphtheria, and pertussis (Tdap) is preferred over Tetanus and diphtheria (Td) if not previously given 1

6. Consider Rabies Prophylaxis

   • Consult local health officials to determine if rabies vaccination should be initiated 1
   • Especially important for feral or wild animal bites 1

Common Pitfalls and Caveats

1. Infection Risk

   • Dog bite wounds have an overall infection rate of approximately 16% 6
   • Hand wounds have significantly higher infection rates than other body locations 3
   • Prophylactic antibiotics reduce infection risk (relative risk 0.56) 6

2. Delayed Presentation

   • Wounds presenting >24 hours after injury should generally not be closed primarily
   • Infected wounds should never be closed 1

3. Special Considerations for Children

   • Children are at highest risk for dog bites, especially to the face 4, 5
   • Facial reconstruction may be needed for avulsive injuries with significant tissue loss 2

4. Follow-up Care

   • Outpatients should be followed up within 24 hours either by phone or during an office visit 1
   • Monitor for signs of infection (increasing pain, redness, swelling, purulent discharge)
   • If infection progresses despite good antimicrobial and ancillary therapy, hospitalization should be considered 1

By following these evidence-based guidelines, clinicians can optimize outcomes for patients with dog bite wounds while minimizing infection risk and maximizing cosmetic results.