Is suturing recommended for dog bites on the hand?

Management of Dog Bites on Hands

Dog bites on the hand should not be sutured and require prophylactic antibiotic therapy due to high infection risk. 1

Rationale for Not Suturing Hand Dog Bites

• Hand dog bites have a significantly higher infection rate (30-50%) compared to bites in other locations due to multiple small compartments and thin soft tissue covering over bones and joints 2
• The hand's complex anatomy with multiple compartments increases risk of infection spreading to tendons, joints, and bones 1
• Primary closure of hand wounds can trap bacteria in these compartments, leading to deep space infections 1

Initial Wound Management

• Perform thorough wound irrigation with sterile normal saline (avoid high-pressure irrigation which may spread bacteria deeper) 1
• Debride necrotic tissue to reduce bacterial burden while being cautious not to enlarge the wound unnecessarily 1
• Leave hand wounds open to heal by secondary intention 1
• Elevate the injured hand to reduce swelling and accelerate healing 1

Antibiotic Therapy

• Prophylactic antibiotics are strongly recommended for all dog bites to the hand for 3-5 days 1
• Use antimicrobial agents active against both aerobic and anaerobic bacteria 1
• First-line therapy: Amoxicillin-clavulanate 875/125 mg twice daily 1
• Alternative options for penicillin-allergic patients:
  • Doxycycline 100 mg twice daily (excellent activity against Pasteurella multocida) 1
  • Combination of trimethoprim-sulfamethoxazole plus metronidazole for anaerobic coverage 1

Special Considerations

• Assess tetanus immunization status and provide prophylaxis if needed 1
• Consider rabies post-exposure prophylaxis in consultation with local health officials 1
• Monitor closely for signs of infection (increasing pain, swelling, erythema, purulent drainage) 3
• Complications to watch for include septic arthritis, osteomyelitis, tenosynovitis, and rarely bacteremia 1
• Extended antibiotic therapy (3-4 weeks) is required if complications like osteomyelitis or septic arthritis develop 1

Follow-up Care

• All patients with hand dog bites should be re-evaluated within 24-48 hours 1
• If infection progresses despite appropriate antimicrobial therapy, consider hospitalization for intravenous antibiotics 1
• Pain disproportionate to injury severity near a bone or joint may suggest periosteal penetration requiring more aggressive management 1

Common Pitfalls to Avoid

• Suturing dog bites on hands increases infection risk significantly 4, 5
• Delaying antibiotic therapy beyond 24 hours after injury 1
• Using first-generation cephalosporins (e.g., cephalexin) or macrolides as monotherapy, as they have poor activity against Pasteurella multocida 1
• Failing to consider deep structure involvement (tendons, joints, bones) in hand injuries 2
• Inadequate wound irrigation and debridement 1