Should sutures be used to close a canine bite wound?

From the Guidelines

Suturing a canine bite wound is generally not recommended, as it can increase the risk of infection, and instead, the wound should be left to heal by secondary intention after thorough cleaning and debridement. The decision to suture or not should be individualized based on the size and location of the wound, as well as the time interval since the bite 1. According to the most recent guidelines, primary closure of dog bite lacerations and perforations was associated with an infection rate of <1%, but closing wounds of the hand may be associated with a higher infection rate than other locations 1.

Key Considerations

• Thorough wound cleansing with water or a dilute water povidone-iodine solution is crucial to decrease the risk of bacterial infection 1
• Antibiotic prophylaxis should be considered, with amoxicillin-clavulanate (Augmentin) being a common choice, typically at a dose of 875/125 mg twice daily for adults for 3-5 days
• Tetanus prophylaxis should be updated if needed, and rabies risk should be assessed based on the circumstances of the bite and the dog's vaccination status
• Specific exceptions where suturing might be considered include:
  • Facial wounds (for cosmetic reasons)
  • Wounds with significant tissue loss
  • Wounds involving critical structures like tendons or blood vessels
  • In these cases, the wound may be loosely sutured after thorough cleaning, often with drains placed to allow fluid drainage

Wound Management

• The wound should be thoroughly cleaned with soap and water or saline solution
• Any devitalized tissue should be debrided
• After cleaning, the wound should be covered with a sterile dressing that's changed regularly
• The patient should be monitored for signs of infection, such as increased redness, swelling, or purulent discharge.

From the Research

Suture Use in Canine Bite Wounds

• The decision to use sutures in canine bite wounds is a topic of debate, with various studies presenting different findings 2, 3, 4, 5, 6.
• According to a study published in the American Family Physician, wounds may be closed if cosmetically favorable, such as wounds on the face or gaping wounds 2.
• A study published in the Veterinary and Comparative Orthopaedics and Traumatology journal found that primary wound closure for dog bites may be associated with a higher infection rate, but the cosmetic appearance after primary closure was still acceptable 3.
• Another study published in the JAMA journal suggested that dog bite wounds may be sutured after debridement and thorough irrigation, unless they are located on the hand, where infection is common 4.
• A randomized controlled trial published in the Injury journal found that primary suturing of wounds caused by dog bites resulted in similar infection rates compared to non-suturing, but primary suturing exhibited improved cosmetic appearance 5.
• A systematic review published in the Cochrane Database of Systematic Reviews found that the potential benefits and harms of primary closure compared with delayed or no closure for mammalian bites remain uncertain, and more robust trials are needed 6.

Infection Rates and Cosmetic Appearance

• The infection rates for primary closure versus non-closure or delayed closure of dog bite wounds were found to be similar in some studies 3, 5.
• However, the cosmetic appearance of the sutured wounds was found to be significantly better in some studies 3, 5.
• The time of management was found to be critical, with early treatment resulting in lower infection rates and improved cosmetic appearance regardless of suturing or not 5.

Antibiotic Prophylaxis and Wound Management

• Antibiotic prophylaxis should be considered, especially if there is a high risk of infection, such as with cat bites, with puncture wounds, with wounds to the hand, and in persons who are immunosuppressed 2.
• Wounds should be cleaned, copiously irrigated with normal saline, and explored for tendon or bone involvement and possible foreign bodies 2.
• The need for rabies prophylaxis should be addressed with any animal bite, as even domestic animals are often unvaccinated 2.