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Retrospective analysis of facial dog bite injuries at a Level I trauma center in the Denver metro area

Gurunluoglu, Raffi MD, PhD; Glasgow, Mark DDS; Arton, Jamie PA-C; Bronsert, Michael PhD

Journal of Trauma and Acute Care Surgery: May 2014 - Volume 76 - Issue 5 - p 1294–1300
doi: 10.1097/TA.0000000000000185
Original Articles

BACKGROUND Facial dog bite injuries pose a significant public health problem.

METHODS Seventy-five consecutive patients (45 males, 30 females) treated solely by plastic surgery service for facial dog bite injuries at a Level I trauma center in the Denver Metro area between 2006 and 2012 were retrospectively reviewed. The following information were recorded: breed, relationship of patient to dog, location and number of wounds, the duration between injury and surgical repair and dog bite incident, type of repair, and antibiotic prophylaxis. Primary end points measured were wound infection, the need for revision surgery, and patient satisfaction.

RESULTS Ninety-eight wounds in the head and neck region were repaired (46 children; mean age, 6.8 years) and (29 adults; mean age, 47.3 years). Twelve different breeds were identified. There was no significant association between the type of dog breed and the number of bite injuries. The duration between injury and repair ranged from 4 hours to 72 hours (mean [SD], 13.7 [10.9] hours). The majority of bite wounds (76 of 98) involved the cheek, lip, nose, and chin region. Direct repair was the most common surgical approach (60 of 98 wounds) (p < 0.05). There was no statistically significant association between wounds needing reconstruction versus direct repair according to dog breed (p = 0.25). Ten wounds required grafting. Twenty-five wounds were managed by one-stage or two-stage flaps. Only three patients (3.06 %) underwent replantation/revascularization of amputated partial lip (n = 2) and of cheek (n = 1). There was one postoperative infection. Data from five-point Likert scale were available for fifty-two patients. Forty patients were satisfied (5) with the outcome, while five patients were somewhat satisfied (4), and seven were neutral.

CONCLUSION Availability of the plastic surgery service at a Level I trauma center is vital for the optimal treatment of facial dog bite injuries. Direct repair and reconstruction of facial dog bite injuries at the earliest opportunity resulted in good outcomes as evidenced by the satisfaction survey data and low complication rate.

LEVEL OF EVIDENCE Therapeutic study, level V. Epidemiologic study, level III.

Supplemental digital content is available in the article.

From the Plastic and Reconstructive Surgery (R.G., J.A.), and Oral Maxillofacial Surgery (M.G.), Denver Health Medical Center, University of Colorado Health Sciences Center, Denver; and Colorado Health Outcomes Program (COHO) (M.B.), University of Colorado, Aurora, Colorado.

Submitted: October 25, 2013, Revised: December 20, 2013, Accepted: December 24, 2013.

This study was in part presented in the 40th annual Rocky Mountain Trauma and Emergency Medicine Conference, June 25–28, 2013, in Breckenridge, Colorado.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

Address for reprints: Raffi Gurunluoglu, MD, PhD, Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, 777 Bannock St, Denver, CO 80204; email: raffi.gurunluoglu@dhha.org.

© 2014 Lippincott Williams & Wilkins, Inc.