Twenty-nine of 108 patients who presented to our hospital setting needed hospitalization after preliminary treatment based on the discussed treatment algorithm. Among these 29 patients, 20 patients (69%) were hospitalized for a short term of 1–3 days. Nine patients (31%) needed 4–11 days of extended hospitalization.
The biggest reason for extended hospitalization in these 9 patients was infection. Other reasons included reimplantation failure, concurrent injuries such as skull fracture and subarachnoid hematoma. Most of these patients were among the groups who received IV antibiotics at the outside hospital for 48 hours without any improvement and was referred to Westchester Medical Center for further care. Most notable was that of the 9 patients with extended hospitalization, 6 (66.7%) were caused by a pit bull that confirms our theory that this breed results in the most devastating injuries at our center. The penetrating and crushing nature of these bites can lead to lifelong deformities (Figs. 4–7).
It is important to note that due to the retrospective nature of the medical record data, certain variables such as breed of dog could not be independently verified. Our center may also have an inherent bias toward treating the most complicated cases that cannot be treated at a typical community hospital and therefore our data may be skewed toward the patient population with more devastating injuries caused by “larger biting dogs.” Similarly, we may have a bias toward under reporting of the postoperative complications because many patients were referred from centers hours away and would have reported any outcomes-related issues to their primary doctor. In summary, dog bite injuries remain a common form of pediatric trauma that require medical attention, with potential psychological and emotional sequelae in children.12 Hence, to address these injuries, it is of utmost importance to seek care at medical centers that have available trauma, plastic surgery, and psychological support services.
Parents or guardian provided written consent for the use of the patients’ images.
1. Gilchrist J, Sacks JJ, White D, et al. Dog bites: still a problem? Inj Prev. 2008;14:296–301.
2. 2014 Plastic surgery statistic report. American Society of Plastic Surgeons. 2014.Available at www.plasticsurgery.org
3. Mouro S, Vilela CL, Niza MM. Clinical and bacteriological assessment of dog-to-dog bite wounds. Vet Microbiol. 2010;144:127–132.
4. Golinko MS, Arslanian B, Williams JK. Characteristics of 1616 consecutive dog bite injuries at a single institution. Clin Pediatr (Phila). 201756:316–325.
5. Beck AM, Jones BA. Unreported dog bites in children. Public Health Rep. 1985;100:315–321.
6. Henry HC, Neumeier AT, Davies BW, et al. Analysis of pediatric facial dog bites. Craniomaxillofac Trauma Reconstr. 2013;6:225–232.
7. Kasbekar AV, Garfit H, Duncan C, et al. Dog bites to the head and neck in children; an increasing problem in the UK. Clin Otolaryngol. 2013;38:259–262.
8. Bini JK, Cohn SM, Acosta SM, et al; TRISAT Clinical Trials Group. Mortality, mauling, and maiming by vicious dogs. Ann Surg. 2011;253:791–797.
9. Kaye AE, Belz JM, Kirschner RE. Pediatric dog bite injuries: a 5-year review of the experience at the Children’s Hospital of Philadelphia. Plast Reconstr Surg. 2009;124:551–558.
10. Rui-feng C, Li-song H, Ji-bo Z, et al. Emergency treatment on facial laceration of dog bite wounds with immediate primary closure: a prospective randomized trial study. BMC Emerg Med. 2013;13:S2.
11. Paschos NK, Makris EA, Gantsos A, et al. Primary closure versus non-closure of dog bite wounds. a randomised controlled trial. Injury. 2014;45:237–240.
12. O’Brien DC, Andre TB, Robinson AD, et al. Dog bites of the head and neck: an evaluation of a common pediatric trauma and associated treatment. Am J Otolaryngol. 2015;36:32–38.
13. Gurunluoglu R, Glasgow M, Arton J, et al. Retrospective analysis of facial dog bite injuries at a level I trauma center in the Denver metro area. J Trauma Acute Care Surg. 2014;76:1294–1300.
14. Chen HH, Neumeier AT, Davies BW, et al. Analysis of pediatric facial dog bites. Craniomaxillofac Trauma Reconstr. 2013;6:225–232.
15. Calkins CM, Bensard DD, Partrick DA, et al. Life-threatening dog attacks: a devastating combination of penetrating and blunt injuries. J Pediatr Surg. 2001;36:1115–1117.
16. Cornelissen JM, Hopster H. Dog bites in The Netherlands: a study of victims, injuries, circumstances and aggressors to support evaluation of breed specific legislation. Vet J. 2010;186:292–298.
17. Eppley BL, Schleich AR. Facial dog bite injuries in children: treatment and outcome assessment. J Craniofac Surg. 2013;24:384–386.
18. Mcheik JN, Vergnes P, Bondonny JM. Treatment of facial dog bite injuries in children: a retrospective study. J Pediatr Surg. 2000;35:580–583.
19. Monroy A, Behar P, Nagy M, et al. Head and neck dog bites in children. Otolaryngol Head Neck Surg. 2009;140:354–357.
20. Wu PS, Beres A, Tashjian DB, et al. Primary repair of facial dog bite injuries in children. Pediatr Emerg Care. 2011;27:801–803.
21. Mitchell RB, Nañez G, Wagner JD, et al. Dog bites of the scalp, face, and neck in children. Laryngoscope. 2003;113:492–495.