Immediate versus delayed closure of facial dog-bite wounds: Retrospective analysis and nursing care experience

Facial dog-bite injuries present a complex surgical challenge, balancing infection prevention with optimal cosmetic outcomes. While delayed primary closure (DPC) has traditionally been preferred to mitigate infection risk, immediate primary closure (IPC) may enhance healing and aesthetic results. However, IPC remains underutilized due to concerns about surgical site infection (SSI), particularly in contaminated wounds. A retrospective cohort study was conducted at a tertiary center in Western China from 2020 to 2024. A total of 212 patients presenting within 24 hours of facial dog-bite injury were included. Patients received either IPC (n = 120) or DPC (n = 92) following standardized debridement and antibiotic protocols. The primary outcome was SSI within 7 days. Secondary outcomes included time to epithelialization, scar quality at 3 months, and pain scores. Multivariate logistic regression was used to identify independent predictors of infection. The overall SSI rate was 12.7%, with no significant difference between IPC (12.5%) and DPC (13.0%) groups (P = .92). Multivariate analysis identified wound area as the sole independent predictor of SSI (odds ratio 1.53 per cm2; P = .005). IPC was associated with faster epithelialization (median 18 vs 20 days; P = .02) and superior cosmetic outcomes, with lower Vancouver scar scale and higher modified Stony Brook scar evaluation scale scores at 3 months (P < .001). IPC of facial dog-bite wounds, when performed with rigorous debridement and structured nursing care, is safe and yields better cosmetic outcomes than DPC. Wound size should guide closure decisions and infection risk stratification.