Should dog bites be sutured?

Management of Dog Bite Wounds: To Suture or Not to Suture

Dog bite wounds should generally not be sutured when possible, as suturing increases the risk of infection and may compromise patient outcomes. 1

Initial Wound Management

Proper initial management of dog bite wounds is critical to prevent infection and optimize healing:

1. Immediate wound cleansing:

   • Thorough irrigation with water or dilute povidone-iodine solution
   • Use copious amounts of fluid under pressure to reduce bacterial load
   • This step alone significantly reduces the likelihood of rabies and bacterial infection 1

2. Wound assessment:

   • Evaluate for damage to underlying structures (nerves, tendons, blood vessels)
   • Check for foreign bodies
   • Assess wound depth and contamination level

3. Debridement:

   • Remove devitalized tissue
   • Cautious debridement to preserve viable tissue

Suturing Decision Algorithm

The decision to suture dog bite wounds should follow this algorithm:

Do Not Suture:

• Most dog bite wounds (general recommendation) 1
• Hand or foot wounds (high infection risk) 1
• Puncture wounds
• Heavily contaminated wounds
• Wounds presenting >8 hours after injury 2
• Wounds in immunocompromised patients

Consider Suturing Only For:

• Facial wounds (for cosmetic reasons) 1
• Large gaping wounds that cannot heal by secondary intention
• Clean wounds presenting early (<8 hours) 2

Antibiotic Prophylaxis

Antibiotic prophylaxis is recommended for:

• Immunocompromised patients
• Asplenic patients
• Patients with advanced liver disease
• Wounds with resultant edema
• Moderate to severe injuries
• Hand or face injuries
• Injuries that may have penetrated periosteum or joint capsule 1

First-line antibiotic: Amoxicillin-clavulanate for 3-5 days 1, 3

Rabies Prophylaxis Considerations

For all dog bites, consider rabies risk:

• Assess vaccination status of the dog
• Determine if attack was provoked or unprovoked (unprovoked attacks more concerning for rabies) 1
• Consult local health officials regarding need for rabies prophylaxis 1
• If indicated, administer rabies immune globulin and vaccine series 1

Tetanus Prophylaxis

Administer tetanus prophylaxis based on wound characteristics and patient's immunization history 1

Special Considerations

Timing of Treatment

Wounds treated within 8 hours of injury show significantly lower infection rates (4.5% vs 22.2% for wounds treated after 8 hours) 2

Cosmetic Outcomes

While primary closure may provide better cosmetic outcomes (Vancouver Scar Scale 1.74 for sutured vs 3.05 for non-sutured wounds) 2, this benefit must be weighed against the increased infection risk, particularly for non-facial wounds.

High-Risk Wounds

Hand wounds have particularly high infection rates and should generally not be sutured 4

Common Pitfalls to Avoid

1. Premature closure: Closing contaminated wounds increases infection risk
2. Inadequate irrigation: Thorough cleansing is essential for infection prevention
3. Overlooking rabies risk: Always assess need for rabies prophylaxis
4. Neglecting tetanus status: Update tetanus prophylaxis as needed
5. Delayed treatment: Wounds should ideally be treated within 8 hours

By following these guidelines with emphasis on thorough wound cleansing and selective suturing only when appropriate, you can minimize infection risk and optimize outcomes for patients with dog bite wounds.