Dog bites usually require treatment by a plastic surgeon because victims of severe dog attacks, more often children, suffer severe tissue damage that may require multiple procedures including plastic reconstructive surgery, tissue expansion, and multiple scar revisions.
Why Should I Contact a Plastic Surgeon to Treat a Dog Bite? (Video)
Dr. Sarah Frommer, a craniofacial and pediatric plastic surgeon from the Craniofacial Team of Texas in Austin, Texas has developed a video to demonstrate improved outcomes when a plastic surgeon is consulted on the surgical repair and treatment of complex dog bites to the ear and face. Below is a video of a patient who had a dog bite to his ear. This was repaired by an emergency department physician and he was given follow up in our plastic surgery office at the Craniofacial Team of Texas. There was some missing tissue on his helix (prominent rim of the ear) and so the patient chose to undergo a revision of the repair in our office to have better restoration of the ear. Look at the amazing results only 3 weeks after repair!
The Incidence of Dog Bites in Children
Per report by the AKC (American Kennel Club) in 2015, every year 800,000 Americans or one out of every five of those dog bites causes an injury that requires medical attention according to the Centers for Disease Control; and at least half that number are children. Although strays or other unfamiliar dogs can bite, most of the time people are actually bitten by a dog they know, which could be a friend’s dog or even the family pet; according to DogsBite.org, in 2016, family dogs inflicted 45% of all dog bite fatalities. Additionally, in 2013, Texas was listed in the top 5 states for dog bite claims according to State Farm and the Insurance Information Institute.
Repair of Dog Bites
According to American Society of Plastic Surgeons, in 2015, more than 26,000 people underwent reconstructive surgery as a result of being bitten by dogs. Dr. Sarah Frommer has considerable experience taking care of dog bites of the face, extremities, and body; she was affectionately called the “dog bite expert” during her fellowship.
Dog bites, especially those on the face, should be evaluated by a plastic surgeon to reduce the chance of complications such as infection and deformity. First, a thorough history will be taken which will include the dog’s Rabies immunization status and the patient’s tetanus immunization status. Next, the wound location will be evaluated to make sure there is no injury to important structures such as arteries, nerves, ducts, etc. Then, depending on the extent of injury and patient age, the wound can be taken care of under local or general anesthesia.
A plastic surgeon is specialty trained to take care of wounds, which means being able to properly debride a wound free of dead tissue and foreign bodies, which would inhibit healing and cause infection. Although an important goal is to reduce deformity from the injury, the primary goal in treating dog bites is to prevent infection and promote good healing.
Complications of Dog Bites
A dog bite can be a devastating injury and needs to be properly taken care of to avoid serious complications, such as:
- Infection – No amount of antibiotics can replace doing a thorough debridement and proper management of a wound! If a wound is deep or is infected, then a plastic surgeon will place a small drain or leave it open to allow the body to heal the wound from the inside out. This avoids creating pockets where bacteria can grow and cause an abscess. Once the infection is treated and the wound has healed, the wound can be revised to improve its appearance.
- Damage to important structures – As with any traumatic injury, it is important to assess if deeper structures such as arteries, nerves, bone, tendon, etc are involved. For example, in the face there is an important nerve called the facial nerve which is responsible for activating the muscles for facial expression. If this nerve is injured and it is not recognized and repaired, then it can result in paralysis of the facial muscles.
- Deformity – On the face, there are many cosmetically sensitive areas such as the lips, nose, ear, and eyes. When dogs bite, they tend to tear tissue which can result in loss of tissue. Having a plastic surgeon manage a dog bite on the face can improve the final appearance of the wound. In the video above, Dr. Frommer had to address missing tissue on the patient’s helix to restore the natural ear contour.
Prevention of Dog Bites
Dog bite prevention advice from the Humane Society of the United States:
- Respect the dog’s personal space
- Never approach an unfamiliar dog, especially one that is tied up or confined
- Do not pet a dog, even your own, without letting them see and sniff you first
- Do not disturb a dog while they are sleeping, eating, chewing on a toy or caring for puppies
- Pay attention to body language – tense body, stiff tail, pulled back head/ears, furrowed brow, eyes rolled so that the whites are visible, flicking tongue, backing away, intense stare – these are warning signs to slowly back away from the dog
If you or your child has experienced a facial dog bite injury and would like a plastic surgery consult, please contact the Craniofacial Team of Texas in Austin by calling 512-377-1142 or toll free 877-612-7069 to schedule an appointment or complete an online appointment request.