What are the physical management steps for a dog bite wound?

Physical Management of Dog Bite Wounds

The physical management of dog bite wounds requires thorough wound cleansing with sterile normal saline and copious irrigation to prevent infection. 1

Initial Assessment and Wound Cleansing

1. Wound Assessment

   • Examine for neurovascular function (pulses, sensation) and range of movement of adjacent joints 2
   • Assess wound type: puncture, crush, laceration, or avulsion 1
   • Document location and depth of wound (hand bites carry higher infection risk) 1

2. Wound Cleansing

   • Irrigate thoroughly with large volume of warm or room temperature potable water 1
   • Consider povidone-iodine solution for irrigation as a virucidal agent 1
   • Remove any superficial debris but avoid deeper debridement unless necessary 1
   • Iodine or antibiotic-containing solutions are not necessary for initial cleaning 1

Wound Closure Considerations

• Fresh wounds (<8 hours old):

  • May be approximated with Steri-Strips rather than sutures 1
  • Facial wounds can be closed primarily 1
  • Primary closure may be performed if there is low risk of infection 2

• Do not close:

  • Infected wounds 1
  • Heavily contaminated wounds 1
  • Hand wounds (higher infection risk) 1

Additional Physical Management

• Elevation: Elevate the injured area, especially if swollen, to accelerate healing 1
• Immobilization: Consider passive immobilization methods as needed 1
• Specialized Care: Consider consultation with a hand specialist if joint spaces or tendons are involved 1

Medical Interventions to Consider

1. Antibiotic Prophylaxis

   • Amoxicillin-clavulanate (875/125 mg twice daily for 3-5 days) is first-line 1
   • Especially important for:
     • Hand or face bites
     • Deep puncture wounds
     • Immunocompromised patients
     • Wounds with significant tissue damage

2. Tetanus Prophylaxis

   • Administer tetanus toxoid (0.5 mL intramuscularly) if vaccination is outdated (>5 years) or status unknown 1
   • Tdap preferred over Td if not previously given 1

3. Rabies Prophylaxis Assessment

   • Combination of Rabies Immune Globulin (RIG) and vaccine for both bite and nonbite exposures 1
   • Administer 20 IU/kg body weight of RIG, infiltrating around and into the wound 1
   • Bites that don't break the skin generally don't require rabies prophylaxis 2

Follow-up Care

• Schedule follow-up within 24-48 hours to assess for signs of infection 1
• Monitor for increasing redness, swelling, pain, warmth, or drainage 1
• Consider hospitalization if infection progresses despite appropriate therapy 1

Common Pitfalls to Avoid

• Inadequate irrigation: Insufficient irrigation is a common cause of wound infection
• Premature closure: Closing infected or heavily contaminated wounds increases infection risk
• Overlooking deep structures: Failing to assess for damage to tendons, nerves, or joints, particularly in hand wounds
• Inappropriate antibiotic selection: First-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and clindamycin alone have poor activity against Pasteurella multocida and should be avoided 1
• Delayed follow-up: Bite wounds can deteriorate rapidly and require prompt reassessment