Dog bites of the face with tissue loss

Children are most frequently the victims of dog bites; the face is often the favored target. Even in apparently extensive injuries, enough skin generally remains to allow a reasonably direct closure, which is the preferred treatment. Infrequently, when significant soft tissue loss occurs, more complex methods require the surgeon's ingenuity in order to restore function and cosmesis without risking widespread infection or disfigurement. This article discusses the use of local flaps, skin grafts, or regional flaps in the proper circumstances. These options must be chosen carefully following an appropriate hierarchy of priorities, in order to achieve wound closure, to simultaneously restore anatomic landmarks, and to lessen the need for subsequent surgical revisions and psychological trauma.