What is the treatment for a facial laceration caused by a dog bite?

Treatment of Facial Laceration from Dog Bite

Facial lacerations from dog bites should be managed with copious irrigation, cautious debridement, primary wound closure, and preemptive antibiotics to optimize both functional and cosmetic outcomes. 1

Initial Management

• Thorough wound cleansing with sterile normal saline or dilute povidone-iodine solution to markedly decrease the risk of bacterial infection 1
• Careful debridement of devitalized tissue while preserving as much viable tissue as possible, especially important for facial wounds 1
• Assessment for potential nerve or tendon damage, which may require specialized repair 1
• Tetanus prophylaxis should be administered if vaccination is not current within the past 5 years for dirty wounds (dog bites are considered dirty wounds) 1

Wound Closure

• Unlike other dog bite wounds, facial lacerations should receive primary closure after thorough cleaning and debridement 1
• Primary closure of facial wounds is recommended due to better cosmetic outcomes and the rich vascular supply of the face which helps prevent infection 1, 2
• Closure techniques should be selected based on the wound characteristics, with attention to proper alignment of anatomical landmarks 2
• Primary closure has been shown to shorten healing time without increasing infection rates in facial dog bite wounds 2

Antibiotic Therapy

• Preemptive antibiotic therapy for 3-5 days is strongly recommended for facial dog bite wounds 1
• Amoxicillin-clavulanate (875/125 mg twice daily) is the preferred oral antibiotic as it covers both aerobic and anaerobic bacteria commonly found in dog bite wounds 1
• Alternative options for penicillin-allergic patients include:
  • Doxycycline 100 mg twice daily (excellent activity against Pasteurella multocida) 1
  • Clindamycin 300 mg three times daily plus trimethoprim-sulfamethoxazole (for anaerobic and aerobic coverage respectively) 1

Rabies Prophylaxis

• Consultation with local health officials is recommended to determine if rabies post-exposure prophylaxis is indicated 1
• If indicated, rabies prophylaxis should include both rabies immunoglobulin and vaccine for previously unvaccinated individuals 1
• Rabies prophylaxis should be administered regardless of the time elapsed since the bite if exposure is confirmed or likely 1

Follow-up Care

• Close monitoring for signs of infection including increasing pain, redness, swelling, or purulent discharge 1
• Elevation of the injured area to reduce swelling 1
• Suture removal typically in 5-7 days for facial wounds 2
• Extended antibiotic therapy (2-4 weeks) may be necessary if complications such as osteomyelitis or septic arthritis develop 1

Special Considerations

• Children are particularly vulnerable to facial dog bites due to their height and exploratory behavior 3
• Wounds involving specialized structures (e.g., tear ducts, facial nerves) may require specialized consultation 4
• The rich vascularity of the face generally allows for better healing and lower infection rates compared to other body locations 2

Common Pitfalls to Avoid

• Delaying primary closure of facial wounds, which can lead to poorer cosmetic outcomes 1, 2
• Inadequate irrigation and debridement, which increases infection risk 1
• Failing to consider rabies prophylaxis, which should be evaluated for all dog bites 1
• Using first-generation cephalosporins, macrolides, or clindamycin alone, which have poor activity against Pasteurella multocida commonly found in dog bites 1