Can a dog bite wound be sutured?

Dog Bite Wound Closure

Primary closure of dog bite wounds after thorough irrigation and debridement is safe and results in superior cosmetic outcomes compared to leaving wounds open, with no significant difference in infection rates.

Wound Closure Decision Algorithm

Wounds That Should Be Sutured:

• Facial wounds: These can and should be closed primarily after meticulous wound care, copious irrigation, and prophylactic antibiotics, ideally by a plastic surgeon 1
• Low-risk wounds presenting within 8 hours: These demonstrate infection rates as low as 4.5% with primary closure 2
• Non-hand, non-puncture wounds in immunocompetent patients: Multiple randomized trials show no increased infection risk with primary closure 2, 3, 4

Wounds That Should NOT Be Sutured:

• Infected wounds at presentation: These must never be closed 1
• Hand wounds: These carry significantly higher infection rates regardless of closure method and warrant special caution 4
• Puncture wounds: High-risk for deep infection 1
• Wounds in high-risk patients: Immunocompromised, asplenic, advanced liver disease, or pre-existing edema 1
• Wounds presenting >8 hours after injury: Infection rates increase to 22.2% with delayed presentation 2
• Cat bites: These carry higher risk (75% Pasteurella multocida colonization) and should generally be left open 5

Evidence Supporting Primary Closure

The infection rate is comparable between sutured and non-sutured wounds (6.7% vs 5%, p=0.093), but cosmetic outcomes are significantly superior with primary closure 3. A randomized controlled trial of 168 patients found overall infection rates of 8.3% with no difference between sutured and non-sutured groups, but sutured wounds had significantly better cosmetic appearance (Vancouver Scar Scale: 1.74 vs 3.05, p=0.0001) 2.

Another controlled trial of 169 dog bite lacerations showed only 7.7% overall infection rate, with seven infections in sutured wounds versus six in unsutured wounds (not statistically significant) 4.

Critical Wound Management Steps

Before Any Closure Decision:

• Immediate thorough irrigation: Use sterile normal saline or dilute povidone-iodine solution with high-pressure irrigation 1, 2. This is crucial as wound cleansing alone markedly reduces rabies risk in animal studies 1
• Careful debridement: Remove superficial debris cautiously to avoid enlarging the wound 1
• Assess for deep structure injury: Pain disproportionate to injury suggests periosteal or joint capsule penetration 1

Antibiotic Coverage:

• Amoxicillin-clavulanate 875/125 mg twice daily is the first-line agent, covering both aerobic and anaerobic bacteria including Pasteurella multocida 1
• Duration: 3-5 days for preemptive therapy in high-risk wounds 1
• Avoid: First-generation cephalosporins, macrolides, and clindamycin monotherapy—all have poor activity against P. multocida 1

Additional Prophylaxis:

• Tetanus toxoid: 0.5 mL IM if status outdated or unknown 1
• Rabies prophylaxis: Consult local health officials, especially for feral/wild animals 1

Common Pitfalls to Avoid

Do not use Steri-Strips as a substitute for proper closure on appropriate wounds—while the 2005 guidelines suggested approximation with Steri-Strips for controversial cases 1, more recent evidence from 2014 supports definitive primary closure for appropriate wounds 2.

Do not delay treatment beyond 8 hours when possible—this is the critical window where infection rates remain lowest (4.5% vs 22.2%) 2.

Do not close hand wounds routinely—these consistently show higher infection rates in both sutured and non-sutured groups 4.

Do not forget elevation—elevating the injured body part, especially if swollen, accelerates healing during the first few days 1.

Timing Considerations

Suturing within 8 hours of injury is controversial according to older guidelines 1, but the most recent high-quality randomized controlled trial from 2014 demonstrates that wounds treated within 8 hours have significantly lower infection rates (4.5%) regardless of closure method, supporting early primary closure for appropriate wounds 2. A 2025 case series further supports immediate primary closure for facial dog bite wounds with excellent outcomes 5.