The Dilemma of Dog Bite Wounds: Primary versus Delayed Closure

The World Health Organization recommends delayed closure of bite wounds, despite controversial studies that advocate or prohibit this practice. This study aimed to compare the outcomes of primary versus delayed closure of pediatric dog bite wounds.

This is a retrospective analysis of the trauma registry at a level I trauma center. Pediatric (<18 y) patients with dog bite wounds were included. Patients were stratified based on wound management into primary versus delayed closure groups. Primary outcomes were infectious complications, including fever, local abscess, local erythema (>2 cm), edema, purulent discharge, and a white blood cell count of >12,000. Multivariable regression analyses were performed to identify the independent effect of primary versus delayed closure on the outcomes, adjusting for potential confounding factors.

A total of 86 pediatric patients were identified. The mean (standard deviation) age was 8 (5) and 50% were male. Head and neck were the most involved body region (80.2%), followed by upper extremities (16.3%). The median wound size was 4 [2-7] cm ranging from 0.1 to 26 cm. There was no difference in terms of wound size (P = 0.607) and depth (0.607) between primary and delayed groups. Overall, 66.3% of patients received antibiotics on arrival and 73.3% were discharged on antibiotics. Overall, 54 (62.8%) underwent primary wound closure. Overall, 11.6% developed infectious complications, with no difference between study groups (primary closure: 11.1% versus delayed closure: 12.5%, P = 0.846). The time to closure was not associated with adjusted odds of infectious complications (adjusted odds ratio 0.875, 95% CI [0.23-3.37], P = 0.875).

Despite the current recommendations, there was no association between the timing of wound closure and infectious complications among pediatric patients presenting with dog bites, regardless of wound size and depth. Future efforts should focus on selected wounds that might benefit from delayed closure despite the purported risks of cosmetic effects.