What is the treatment and management for infections and other problems from a dog bite?
Three important treatment issues that need to be addressed with a dog bite:
- Skin damage
- Injury to underlying tissues such as muscle, nerve, and bone
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 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 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 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 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.