What is the recommended management for suturing a dog bite laceration?

Management of Dog Bite Lacerations

Dog bite lacerations should generally avoid suturing when possible, but primary closure may be performed for facial wounds after thorough cleaning and debridement to optimize cosmetic outcomes. 1

Initial Wound Management

• Immediate gentle irrigation with water or dilute povidone-iodine solution is essential to markedly decrease bacterial infection risk 2
• Thorough wound cleansing is especially important for rabies prevention, as it can significantly reduce the likelihood of rabies transmission even without other prophylaxis 2
• Careful assessment for serious injuries such as nerve or tendon lacerations must be performed 2
• Consider tetanus prophylaxis based on vaccination status, particularly if not current within the past 5 years for contaminated wounds 1

Suturing Considerations

• Primary closure decision algorithm:
  • Face/head wounds: Primary closure recommended after thorough cleaning and debridement due to better cosmetic outcomes and rich vascular supply that helps prevent infection 1
  • Hand wounds: Avoid suturing due to significantly higher infection rates compared to other body locations 3, 4
  • Other body locations: Suturing should be avoided when possible 2
  • Time since injury: Wounds treated within 8 hours have significantly lower infection rates (4.5%) compared to those treated after 8 hours (22.2%) 5

Antibiotic Therapy

• Preemptive antibiotic therapy for 3-5 days is strongly recommended for dog bite wounds, particularly facial lacerations 1
• Amoxicillin-clavulanate (875/125 mg twice daily) is the preferred oral antibiotic, covering both aerobic and anaerobic bacteria commonly found in dog bite wounds 1
• For penicillin-allergic patients, doxycycline 100 mg twice daily is recommended due to excellent activity against Pasteurella multocida 1

Rabies Prophylaxis Considerations

• Consult local health officials to determine if rabies post-exposure prophylaxis is indicated 1
• For previously unvaccinated individuals, rabies prophylaxis should include both rabies immunoglobulin and vaccine 2
• The full dose of human rabies immune globulin (HRIG) should be infiltrated around and into the wound area when indicated 2
• The recommended dose of HRIG is 20 IU/kg body weight 2

Follow-up Care

• Monitor closely for signs of infection including increasing pain, redness, swelling, or purulent discharge 1
• Elevate the injured area to reduce swelling 1
• Extended antibiotic therapy may be necessary if complications develop 1

Common Pitfalls and Caveats

• Inadequate irrigation and debridement significantly increases infection risk 1
• Delaying primary closure of facial wounds beyond 8 hours leads to poorer cosmetic outcomes and higher infection rates 5
• Using first-generation cephalosporins, macrolides, or clindamycin alone provides inadequate coverage against common dog bite pathogens 1
• The overall infection rate for dog bite wounds is approximately 5.5-8.3%, but this varies significantly by location and timing of treatment 6, 5
• Facial wounds have better outcomes in terms of both infection rates and cosmetic appearance compared to extremity wounds 5