Should a lacerated wound at the ear due to a dog bite be sutured?

Management of Dog Bite Laceration to the Ear

Yes, ear lacerations from dog bites should be sutured after thorough wound cleansing and debridement, ideally within 12-24 hours of injury, with concurrent prophylactic antibiotic therapy. 1, 2

Wound Closure Decision

Facial and ear wounds are an explicit exception to the general rule against closing bite wounds. The ear and face have rich vascular supply that reduces infection risk and makes primary closure both safe and necessary for optimal cosmetic outcomes. 1, 2

Timing Considerations:

• Suture within 12-24 hours of injury for best results 1
• Early closure (within 8 hours) is preferred but controversial for most bite wounds; however, facial/ear wounds should be closed primarily after meticulous preparation 1
• Do not close if the wound is already infected (presence of purulent discharge, significant erythema, or established cellulitis) 1, 2

Essential Pre-Closure Wound Preparation

Irrigation and Debridement:

• Copious irrigation with sterile normal saline using a 20-mL or larger syringe 1, 2
• No need for iodine or antibiotic-containing solutions for irrigation 1
• Cautious debridement of devitalized tissue only - preserve as much viable tissue as possible, especially on the ear where tissue loss affects cosmesis 1, 2
• Avoid aggressive debridement that enlarges the wound or impairs closure 1

Special Anatomic Considerations for Ear:

• Assess for auricular cartilage involvement - cartilage injuries require special attention as perichondritis can lead to permanent deformity 1
• If cartilage is exposed or damaged, ensure thorough cleaning to prevent perichondritis and abscess formation 1

Mandatory Antibiotic Prophylaxis

Preemptive antibiotic therapy for 3-5 days is strongly recommended for all dog bite wounds to the ear/face. 1, 2

First-Line Antibiotic:

• Amoxicillin-clavulanate 875/125 mg twice daily - covers Pasteurella multocida (present in 50% of dog bites), Staphylococcus aureus, Streptococcus species, and anaerobes 1, 2

Alternative for Penicillin Allergy:

• Doxycycline 100 mg twice daily with excellent Pasteurella coverage 1, 2
• Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) plus metronidazole or clindamycin for anaerobic coverage 1

Critical Pitfall - Antibiotics to AVOID:

• Do NOT use first-generation cephalosporins (cephalexin), penicillinase-resistant penicillins (dicloxacillin), macrolides (erythromycin), or clindamycin alone - all have poor activity against Pasteurella multocida 1, 2

Additional Required Interventions

Tetanus Prophylaxis:

• Administer tetanus toxoid (0.5 mL IM) if vaccination not current within past 5 years for contaminated wounds like dog bites 1, 2
• Use Tdap if not previously given 2

Rabies Assessment:

• Consult local health department to determine if rabies post-exposure prophylaxis is indicated 1, 2
• Consider for feral/wild animals or in high-prevalence geographic areas 1
• If indicated: rabies immunoglobulin on day 0 plus vaccine series 1, 2

Post-Closure Management

Elevation and Monitoring:

• Elevate the head/affected side to reduce swelling and accelerate healing 1, 2
• Close follow-up within 24 hours (phone or office visit) to monitor for infection 1, 2

Signs Requiring Extended Therapy:

• Watch for pain disproportionate to injury near cartilage - suggests perichondritis 1
• Auricular perichondritis presents as painful swelling, warmth, redness sparing the earlobe 1
• If perichondritis, abscess, or osteomyelitis develops: extend antibiotics to 2-6 weeks and consider surgical drainage 1, 2

Key Clinical Pitfalls to Avoid

• Do not leave ear/facial wounds open - this leads to poor cosmetic outcomes despite the general teaching about bite wounds 1, 2
• Do not use inadequate irrigation - this is the most common cause of subsequent infection 1, 2
• Do not delay closure beyond 24 hours - infection risk increases significantly 1
• Do not close infected wounds - if purulent discharge is present, control infection first with systemic antibiotics before considering delayed closure 1, 2
• Do not forget cartilage-specific complications - auricular perichondritis can cause permanent ear deformity if missed 1