Do dog bites require suturing?

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

Dog bite wounds generally should not be sutured except for facial wounds, which may receive primary closure after thorough irrigation and debridement to optimize cosmetic results.1

Wound Management Principles

• Dog bite wounds are at high risk of infection due to the polymicrobial nature of the oral flora, with approximately 60% yielding mixed aerobic and anaerobic bacteria 2
• Primary wound management should include:
  • Thorough cleansing and copious irrigation with sterile normal saline 1, 3
  • Careful debridement of devitalized tissue 1, 3
  • Exploration for tendon or bone involvement and possible foreign bodies 4

Suturing Guidelines

• Facial wounds: May receive primary closure after thorough irrigation and debridement for optimal cosmetic outcomes 1
• Non-facial wounds: Generally should not be closed primarily but may be approximated rather than fully closed to reduce infection risk 1
• Hand wounds: Require special attention due to higher risk of infection and functional complications; primary closure is typically avoided 1
• Primary closure may be considered if the wound has low risk of infection, but this determination should be made cautiously 3

Infection Risk Factors

• Dog bite wounds have significant infection potential with Pasteurella species isolated from 50% of dog bite wounds, along with staphylococci and streptococci in approximately 40% 2
• Higher infection risk is associated with:
  • Puncture wounds 3
  • Hand injuries 1, 4
  • Wounds with crushed tissue 2
  • Delayed presentation (>8 hours after injury) 2
  • Immunocompromised status 1

Antibiotic Prophylaxis

• Preemptive antimicrobial therapy is recommended for 3-5 days for patients who are:
  • Immunocompromised
  • Asplenic
  • Have advanced liver disease
  • Have edema of the affected area
  • Have moderate to severe injuries
  • Have injuries that may have penetrated the periosteum or joint capsule 1
• Amoxicillin-clavulanate is the preferred antibiotic as it provides coverage against both aerobic and anaerobic bacteria commonly found in dog bite wounds 1, 5, 3

Follow-up Care

• All patients should be seen in follow-up within 48-72 hours to assess for signs of infection and evaluate wound healing progress 1
• Potential complications include:
  • Infectious: cellulitis, abscess formation, septic arthritis, osteomyelitis, and rarely bacteremia
  • Non-infectious: nerve or tendon injury, compartment syndrome, post-traumatic arthritis, and scarring 1

Additional Considerations

• Tetanus prophylaxis should be administered to patients without vaccination within the past 10 years 1, 3
• Consultation with local health officials is recommended to determine if rabies post-exposure prophylaxis should be initiated 2, 1
• A healthy domestic dog that bites a person should be confined and observed for 10 days; any illness during confinement should be evaluated by a veterinarian and reported immediately to the local health department 2

Common Pitfalls to Avoid

• Failing to thoroughly irrigate the wound before considering closure 3
• Closing non-facial wounds primarily, especially hand wounds 1
• Using first-generation cephalosporins or penicillinase-resistant penicillins alone for prophylaxis, as they have poor activity against Pasteurella multocida 2
• Neglecting to evaluate for potential damage to underlying structures such as tendons, nerves, or joints 1, 4
• Overlooking the need for tetanus and rabies prophylaxis assessment 2, 1