Dog Bite

In the U.S., there are about 4.5 million dog bites a year.

• Dog bites account for up to 90% of all animal bites. 4.5 million dog bites occur each year in the U.S., and more than 27,000 victims require reconstructive surgery.
• Injuries may involve structures deep beneath the skin including muscles, bones, nerves, and blood vessels.
• Infections, including tetanus and rabies, need to be considered for a dog bite.
• Wound cleaning decreases the risk of infections from dog bites.
• Skin repair increases the risk of infection, and the decision to suture the skin balances the risk of infection versus the benefit of a better appearing scar.

Almost 70 million dogs live in the United States, and since many victims of dog bites don't seek medical care or report the attack, it may be that the U.S. Center for Disease Control and Prevention (CDC)'s estimate of 4.5 million dog bites each year in the U.S. may be too low. Over one million of dog bite victims go to emergency medical care at hospitals in the U.S. every year.

Dogs have rounded teeth, and it is the pressure exerted by their jaws that can cause significant damage to the tissues under the skin, including bones, muscles, tendons, blood vessels, and nerves.

The risk of being bitten by a dog increases if there is a dog in the home; the more dogs there are, the greater the risk. Men are more frequently bitten by dogs than women, who are bitten by cats more often. Children between the ages of 5 and 9 are more likely to be bitten by a dog than other age groups. Children are also more likely to need medical attention.

If a dog bites you or someone that you are with, you need to go to a safe place away from the dog that has bitten you to prevent further attack and injury. Infants and children should be evaluated after any dog bite.

If there are no signs of skin damage or if there is a small amount of abrasion from a dog bite, it may be reasonable to watch for signs and symptoms of infection (pain, redness, warmth, swelling, and drainage of pus or fluid) before seeking medical care.

Wounds should be kept elevated and if it is possible, you may attempt to clean the dog bite with tap water.

Gather information from the dog's owner about the dog's rabies immunization status, but if this is not possible, hospitals, animal control centers, or law enforcement personnel will help gather any required information.

Since dog bites can cause significant damage beneath the skin, a type of injury that cannot always easily be seen. Moreover, if there is pain at or near the dog bite, underlying tissues, and other structures may have been damaged or if the bite disrupts the skin causing a puncture, laceration, or tear, call your doctor or go to the nearest Urgent Care or Emergency Department.

Three important treatment issues that need to be addressed with a dog bite:

1. Skin damage
2. Injury to underlying tissues such as muscle, nerve, and bone
3. Infection

It is easy to look at a dog bite and see that the skin has been damaged, but it is also important to assess the underlying structures that may have also been injured in the attack. The patient often concentrates on the cosmetic appearance of the wound; while that is important, the health care practitioner may be more concerned about the injuries that will impair the body's function. For example, a laceration to a hand may look bad, but more important than the potential scarring would be a lacerated tendon that would prevent a finger from moving.

The potential for infection from a dog bite is extremely high. Dog bites inoculate bacteria deep into the tissue, and while not as aggressive as cat bites, the majority of dog bites get infected. Common bacteria involved in such infections include Streptococcus, Staphylococcus, and Pasteurella.

Find out if the dog that bit you has current rabies immunizations. If the dog has not been immunized for rabies, the question becomes whether to immunize the patient against the rabies virus. A variety of approaches may be considered depending upon the situation surrounding the bite.

• Is the dog available to be observed?
• Was the bite provoked or defensive rather than an unprovoked attack?
• Where is the bite located?
• What is the past medical history of the victim?

Once the doctor or other healthcare professional has taken a history of the events and examined the patient, most dog bites can be cared for in the emergency department, urgent care centers, or a doctor's office. The physical exam will help decide whether any deep structures like muscle, tendon, nerve, or bone have been damaged.

Commonly, the wound is anesthetized so that it can be explored. This will help confirm the condition of the deep structures and their function. The wound will then be washed with normal saline (a salt-water solution) to irrigate out as much dirt and bacteria as possible.

Once the wound has been cleaned, a decision needs to be made on whether to close the skin. Stitching the skin (to make the scar look better) increases the risk of infection. Balancing the risk of infection against the benefit of a better-looking scar depends upon the location of the injury and the discussion between the doctor and the patient. Dog bites to the face tend to be sutured, while those located on less noticeable parts of the body may be left to heal on their own.

Sometimes, dog bite wounds need surgery to repair the wound if there is considerable skin damage or skin loss, or if there are associated injuries that need treatment.

Some dog bites In infants and children may need surgery to repair lacerations, especially if facial wounds are involved, because of the need for a prolonged anesthetic to keep the patient still.

There is some controversy regarding antibiotic therapy for dog bites. Some doctors routinely prescribe antibiotics while others choose to wait until the wound shows signs and symptoms of potential infection.

If the dog bite victim does not choose to seek medical care, the rabies immunization status of the dog must be determined immediately. Rabies therapy, if necessary, must begin as soon as possible. The victim's tetanus status also needs to be current.

Exposure to a rabid animal does not always result in rabies. If treatment is initiated promptly following a rabies exposure, rabies can be prevented. If rabies exposure is not treated and a person develops clinical signs of rabies, the disease usually results in death.

Dog bites often occur when there is miscommunication between the dog and the victim. It is not common to have an unprovoked attack by a stray dog. Often, it is the dog owner or a family member who is bitten. To prevent being bitten by a dog:

1. Choose a dog breed that is compatible with the family. Aggressive dogs may not be appropriate in a home with infants and small children.
2. Dogs are social animals; therefore, socializing and appropriate training will help minimize the risk of dog bites.
3. Do not approach a stray or unfamiliar dog, especially if the owner is not present.
4. Do not approach a dog with quick motions or from above its head. Allow time for the dog to acknowledge your presence before attempting to pet it.
5. Prior to making contact with a dog, ask the owner if is OK to pet the dog.
6. If a confrontation occurs, do not make eye contact and do not run or scream.
7. Do not approach an unfamiliar dog while it is eating, sleeping, or caring for puppies.
8. Do not leave young children or infants unsupervised with a dog.