Deep Dog Bite Wound Suturing
Primary closure of deep dog bite wounds is generally NOT recommended, with the critical exception of facial wounds, which should be sutured after meticulous irrigation and debridement. 1, 2
Wounds That Should NOT Be Sutured
- Hand wounds carry significantly higher infection rates and should not be primarily closed 1, 3, 4
- Puncture wounds pose high risk for deep infection and should be left open 2
- Infected wounds at presentation must never be closed 2
- High-risk patient wounds (immunocompromised, asplenic, advanced liver disease, or pre-existing edema) should not be sutured 2
- Heavily contaminated wounds should be left open 5
Wounds That CAN Be Sutured
Facial wounds are the exception and should be primarily closed after proper wound preparation, ideally by a plastic surgeon, to optimize cosmetic outcomes 1, 2. Research supports this approach, with one study showing infection rates <1% when facial wounds are properly managed 4.
Non-facial, non-hand wounds may be approximated (edges brought together loosely) rather than fully sutured 1, 6. A randomized controlled trial of 168 patients found no difference in infection rates between sutured (8.5%) and non-sutured (8.1%) wounds when proper wound care was performed 7.
Critical Pre-Closure Wound Management
Before any consideration of closure, these steps are mandatory:
- Copious high-pressure irrigation with sterile normal saline or dilute povidone-iodine solution 2, 7
- Careful debridement of devitalized tissue without unnecessarily enlarging the wound 2, 5
- Assessment for deep structure injury including evaluation for pain disproportionate to visible injury, which may indicate joint capsule or periosteal penetration 2
Timing Considerations
Wounds treated within 8 hours of injury have significantly lower infection rates (4.5%) compared to those treated after 8 hours (22.2%) 7. This timing factor is critical regardless of closure decision.
Mandatory Adjunctive Therapy
All dog bite wounds require:
- Preemptive antibiotics: Amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days for high-risk wounds 2, 6
- Tetanus prophylaxis: 0.5 mL IM if status is outdated or unknown, with Tdap preferred over Td if not previously given 1, 2, 6
- Rabies risk assessment: Consult local health officials, especially for feral or wild animal bites 2, 6
Common Pitfalls to Avoid
The most critical error is closing hand wounds or puncture wounds, which dramatically increases infection risk 1, 3, 4. Another pitfall is inadequate irrigation before closure—simple wound cleansing has been shown in animal studies to markedly reduce rabies transmission risk, and the same principle applies to bacterial contamination 1.
Do not delay treatment waiting for "ideal" conditions. Even wounds presenting many months after injury should receive appropriate management, as rabies incubation periods exceeding 1 year have been documented 1.
Follow-Up Protocol
All patients require evaluation within 48-72 hours to assess for infection signs and wound healing progress 6. This is non-negotiable regardless of whether the wound was closed or left open.