Do you suture dog bites immediately?

Management of Dog Bite Wounds

Dog bite wounds should generally not be sutured immediately, except for facial wounds which can be closed after thorough cleaning, debridement, and antibiotic administration.

Initial Management

• Dog bites should be cleaned immediately with copious irrigation using water or normal saline solution to significantly decrease the risk of bacterial infection 1
• Thorough irrigation should be performed using a 20-mL or larger syringe or a 20-gauge catheter to effectively clean the wound 2
• The wound should be explored for tendon or bone involvement and possible foreign bodies 2

Suturing Decision Algorithm

Facial Wounds

• Facial wounds can be closed primarily after:
  • Copious irrigation
  • Careful debridement
  • Administration of preventive antibiotics 1
• Primary closure of facial wounds provides better cosmetic outcomes (mean Vancouver Scar Scale score of 1.74 for sutured wounds vs. 3.05 for non-sutured wounds) 3

Non-Facial Wounds

• Primary closure of dog bite wounds in areas other than the face is generally not recommended 1
• For non-facial wounds, consider:
  • Approximating edges without complete closure 1
  • Leaving wounds open, especially hand wounds which have a higher risk of infection if closed 1, 4

Timing Considerations

• Wounds treated within 8 hours of injury have significantly lower infection rates (4.5%) compared to wounds treated after 8 hours (22.2%) 3
• Early treatment results in improved cosmetic appearance regardless of suturing decision 3

Antibiotic Prophylaxis

• Early preventive antimicrobial therapy (3-5 days) is recommended for:
  • Immunocompromised patients
  • Asplenic patients
  • Patients with advanced liver disease
  • Wounds with pre-existing or resulting edema
  • Moderate to severe lesions, especially on the hand or face 1
  • Puncture wounds
  • Wounds that have undergone primary closure 5
• Amoxicillin-clavulanate is the first-line prophylactic antibiotic as it is active against both aerobic and anaerobic bacteria commonly found in dog bite wounds 1, 5

Additional Considerations

• Tetanus prophylaxis should be administered to patients who have not been vaccinated in the last 10 years (or 5 years for dirty wounds) 1
• The Tdap vaccine is preferred over the Td vaccine if the former has not been previously administered 1
• Rabies prophylaxis may be necessary - consult local health authorities to determine if vaccination should be initiated 1
• A healthy dog that bites a person should be confined and observed daily for 10 days; any illness should be reported immediately to the local health department 6

Special Considerations

• Hand wounds have a particularly high risk of infection and should generally not be sutured 1, 4
• Larger wounds (>3 cm) may have poorer cosmetic outcomes 3
• The overall infection rate for dog bites is approximately 8.3%, only slightly higher than that for lacerations in general 3, 4